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BUILDING A ROBUST DISSEMINATION PLAN

If an intervention has dissemination potential, then the next step is to build a comprehensive dissemination plan. An effective dissemination plan has four key elements: knowledge of stakeholders and the potential environment in which an intervention will be implemented; persuasive value propositions for the intervention; an infrastructure to support dissemination activities; and a social marketing plan.

Knowledge of the Environment and Its Stakeholders

The first step in developing a dissemination plan is to conduct what is referred to as a “scan.” This involves carefully identifying environments that may be conducive to implementing the intervention and deriving an understanding of what stakeholders in those environments (e.g., administrators, directors of agencies, community groups, organizations) need and want. Understanding the opportunities and potential challenges for implementing an intervention via scans is critical for efficiently moving an intervention into practice.

Typically, environmental and stakeholder scans are conducted following the publication of the trial outcomes for an intervention. However, scans can also be conducted early on in the pipeline as one is developing and evaluating an intervention at the pilot, efficacy, and/or effectiveness study phases (see Curran, Bauer, Mittman, Pyne, & Stetler, 2012). Similarly, in these early and evaluative phases, participants and/or their family members can be asked about their willingness to pay (Jutkowitz, Gitlin & Pizzi, 2010) for an intervention or the best way to promote the program among their peers as part of the battery of questions. Mixed methodologies (see Chapter 11) or community participatory research methods can also be used throughout the research process to understand the perceptions of interventionists, stakeholders, and participants concerning the acceptability and potential value of an intervention (Cornwall & Jewkes, 1995). For example, in the Personalized Reminder Information and Social Management System (PRISM) study (Czaja et al., 2015), individuals who participated in the pilot testing of the PRISM system were asked about the potential value of the system and how the system might enhance their ability to engage in everyday activities.

An environmental scan typically involves examining a combination of sources including conducting a systematic literature review, Internet research, focus group- type discussions with interventionists, and interviews with key informants who have an understanding of current relevant practices and/or community settings that may impact the implementation of an intervention (Berkowitz, 2010). Gathering information about perceptions of the intervention from stakeholders including interventionists and targeted populations also provides relevant information to the dissemination process. Table 21.3 outlines five key elements and related questions for an environmental scan in order to advance a dissemination plan for a proven program.

TABLE 21.3 Elements of, and Questions to Ask in, Environmental and Stakeholder Scans

Element

Relevant Research Questions

Current practice

How is a particular condition or problem currently addressed? What are strengths and limitations of current practices?

Competitive models and other market "threats"

How entrenched is the current way of addressing a problem? Is the environment stable or has it been involved with other successful or failed approaches? Are there new or developing interventions that represent future threats to the proposed new intervention that will need to be addressed? (Kotler, 1999)

Funding and reimbursement opportunities and challenges

How will the intervention be paid for? What are the most common reimbursement or other funding streams available?

Federal, state, and local policy opportunities and challenges

What is the current policy environment that might help or hinder the adoption of an intervention?

Health system or hospital policy opportunities and challenges

What is happening in the system or organization that may provide support for, or hinder the use of, an intervention? (Flood, 2013)

As noted earlier, a scan of stakeholders also typically involves key informant interviews. As Brugha and Varvasovszky (2000) explain, these types of interviews “generate knowledge about the relevant actors so as to understand their behaviors, intentions, interrelations, agendas, interests, and the influence or resources they can bring to bear on decision making” (p. 239). It is important to identify how stakeholders prefer to receive information to learn about evidence-based practices.

There are numerous ways to conduct this analysis depending upon the stakeholders, one’s access to groups, and available budget and resources. One-on-one interviews with stakeholder representatives, such as organizational leaders, policy makers, agency heads, regulators, busy clinicians, or individuals targeted for the intervention are perhaps the easiest and most cost-effective way to obtain an initial sense of how an intervention is viewed. These qualitative conversations can reveal helpful insights concerning the level of engagement and the breadth and representativeness of the respondents’ viewpoints toward an intervention. These interviews also provide an introduction to the intervention to potential decision makers and an opportunity to gauge their initial reactions, concerns, and the nature of their queries.

“Convenience” focus groups are another way to capture stakeholder viewpoints. Using existing monthly meetings, say of hospital nurses or long-term care facility’s social workers, can provide rich information about the perceptions of frontline staff concerning an intervention. This approach requires an able facilitator and a systematic process for transcribing and identifying key issues that emerge from the group discussions. If budget allows, outsourcing this activity and using professionally run focus groups can be helpful. However, this may cost $5,000 per focus group or more (Lee, 2002). Finally, Internet services such as SurveyMonkey, Zoomerang, or Survey Gizmo provide inexpensive and accessible platforms for online surveys that can explore stakeholder attitudes and preferences. Even Facebook can be used to obtain quick feedback from select communities concerning an intervention. Use of these strategies can be helpful with larger groups, particularly later in the process to help determine pricing and even test messaging and other marketing approaches with consumers (e.g., patients, participants, families) before making significant investments in dissemination.

 
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