Strategies to disseminate evidence that will: Techniques to explain uncertain evidence using: Intermediate outcomes for all target audiences. Clinical or community settings in the United States, such as: Any other country not specified for inclusion, Sources: Owens et al. The Institute of Medicine’s list of 100 priority topics for CER highlights the importance of translating and disseminating this research.2 The specific topic (“compare the effectiveness of dissemination and translation techniques to facilitate the use of CER by patients, clinicians, payers, and others”) was listed among the first quartile of topics recommended for initial focus. We expect some overlap in results among the three searches (for the three KQs). In this discussion, we evaluate this assumption in the light of our results and existing literature. Champions (aka a cheerleader), such as someone who takes ownership of the evidence and visibly promotes it within his or her own organization or across other settings. In several rheumatology patient networks, we have recognised that white, female and higher educated patients are often overrepresented [42]. Woloshin S, Schwartz LM. Practice guidelines are those documents that present the best evidence for a given protocol of treat-ment or care. The criteria also address intervention content that is specific to each KQ. Global Research Dissemination and Utilization: Recommendations for Nurses and Nurse Educators. Maximov D, Lesnyak O. Biases may result from study design, study conduct, or confounding by other external variables. PubMed Google Scholar Dissemination strategies are concerned with the packaging of the information about the intervention and the communication channels that are used to reach potential adopters and target audience. The overall strength of evidence grade is made up of judgments about four required domains. Passive dissemination strategies include mass mailings, publication of information including practice guidelines, and untargeted presentations to heterogeneous groups. Patient partnership in decision-making on biomedical research: changing the network. Google ScholarÂ. Therefore, we will integrate the information qualitatively into understandable text and summary tables. The use of different approaches can help to increase awareness and use among target populations [26]. The use of passive dissemination strategies, such as a leaflet or brochure, has proven to be insufficient to educate patients or change daily routine because such information does not endure in the long term [23]. Other authors [39] suggest to use a participatory (action) research (PAR) in order to involve patients in the development of guidelines/lay versions. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. Those champions assist in the dissemination of information to patients [6]. We expect that most studies will focus on intermediate outcomes because they occur sooner and, thus, are more practical to study. (2001). Patient and public involvement in guidelines. We do, however, know that event-based knowledge mobilisation may be effective for the initial dissemination of guidelines. The training could be in technical areas such as how to understand the terminology or how to take part in the group effectively (e.g. Implement Sci. They can provide information on their websites, can coordinate web-communities, can organise self-management trainings and other educational events and publish patient magazines, books and brochures. Jae Jeong H, Pham JC, Kim M, Engineer C, Pronovost P. Major cultural-compatibility complex: considerations on cross-cultural dissemination of patient safety programmes. The GIN supports patient involvement in guideline activities around the world. Drouin D. Dissemination and implementation of recommendations on hypertension: the Canadian experience. Cookies policy. Training and support for patients are described as helpful and are therefore needed to make the involvement of patients in the development and dissemination of recommendations successful [2, 22, 38] which in the end will lead to more successful dissemination of the guidelines to patients and patient organisations. Disagreements between the two reviewers will be resolved by discussion and consensus or by consulting a third, senior member of the team. The synthesis of the scientific literature presented in the final report does not necessarily represent the views of individual reviewers. Organ Behav Hum Decis Processes 1996 Dec;68(3): 301-17. We will exclude studies that examine interpersonal communication techniques given that these are more costly to implement and less practical when reaching large-scale audiences. In addition, we expect a fair amount of heterogeneity across studies. To our knowledge, there is no overarching framework of communication strategies to guide our review. Washington, DC: Office of the Assistant Secretary for Health, Office of the Secretary, U.S. Department of Health and Human Services. 290-2007-10056-I #7 from the Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services. Several authors stress, based on their own experiences and ideas [1, 22–25] or a qualitative study among professionals [36], the importance of the involvement of patients or patient organisations in the design and development of recommendations to enhance the dissemination of recommendations in health care and to local patient organisations. Data sources: We searched MEDLINE®, the Cochrane Library, Cochrane Central Trials Registry, PsycINFO®, and the Web of Science. This process is called dissemination. Article  Higgins JPT, Altman DG. Not only are the scientific journals in which recommendations are published inaccessible for patients, they are also written in a language that cannot be understood by patients with low or moderate health literacy. Med Decis Making. Communication Strategies for Health Services Researchers Dissemination Strategies for Health Services Researchers. Criteria 1 AND 2 were mandatory together with criteria 3 OR 4. Involving good-informed patients in their treatment decisions is assumed to lead to more personal comfort with the treatment decision [2], better treatment adherence and motivation, reduction of the number of interventions in some cases [4] and more control by patients [5]. Although Cochrane suggests to exclude descriptive papers, editorials or opinion papers, we have included those papers because of the lack of articles with a level of evidence of 1 (meta-analysis of randomised controlled trials) or 2 (single randomised controlled trials). The last step is the patient test phase. We also will include comparisons within the rows below given the current state of the literature and the lack of comparative information within these groupings. The search terms and strategies were discussed in the research team (TA, MB, KS, MdW). 2009;19(3):401–15. Van Eijk-Hustings Y, Buss B, Fayet F, Moretti A, Ndosi M, Ryan S, et al. 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). Block 1 countries include: France, Germany, Italy, The Netherlands, the United Kingdom, and the United States. Ann Intern Med 2007 Dec 18;147(12):871-5. It is important for you to consider who will be affected by your guideline and its... 3. … Do not forget the professional—the value of the FIRST model for guiding the structural involvement of patients in rheumatology research. For example, a study that compares targeting information to different types of audience segments (e.g., by race or ethnicity, sex or gender, and/or age groups) will be excluded. To choose the right dissemination strategies means thus to combine passive and active strategies. The development group may not include a consumer representative but may invite patients to review draft documents or attend a group meeting or internet forum to share their perspectives [22]. We will exclude Federal and State policymakers because they have less direct impact on clinical decisionmaking when compared with patients and providers. Can J Diabetes. Noar SM, Benac CN, Harris MS. Mitton C, Adair CE, McKenzie E, et al. PMID: 11281931. 20 Dissemination of Findings: How to Share Results Once the evaluation is completed, it is important to share the results and/or evaluation procedures with a variety of stakeholders. Technical experts do not do analysis of any kind nor contribute to the writing of the report. Article  Strategies and techniques discussed in this review could be beneficial for several audiences. 2015;17(5):484–90. Vol 4. Precision reflects the degree of random error surrounding an effect estimate with respect to a given outcome; such studies express dispersion around a point estimate of risk, such as a confidence interval, which indicates the reproducibility of the estimate. J Gen Intern Med. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Studies evaluating dissemination strategies, involving patients and/or reaching patients, were included. Missing information often leads to ratings of medium as opposed to low risk of bias. Stacey D, Légaré F, Col NF, Bennett CL, Barry MJ, Eden KB, et al. Implement Sci. Lustria MLA, Noar SMC, Van Stee SK, et al. J Health Commun 2009 Jan-Feb;14(1):15-42. To be included in our final article, the article had to refer to (1) guideline(s) or recommendation(s), (2) dissemination, (3) dissemination with patients/patient organisations and (4) dissemination for patients/patient organisations. Article  Effectiveness of guideline dissemination and Implementation strategies on health care professionals’ behaviour and patient outcomes in the cancer care context: a systematic review protocol. Allu et al. The authors declare that they have no competing interests. CMAJ 2003 Jul 8;169(1):30-1. This article gives an overview of tools and strategies to disseminate recommendations to patients. Educational outreach and academic detailing are the most consistently effective interventions reported. Divergent and conflicted opinions are common and perceived as healthy scientific discourse that results in a thoughtful, relevant systematic review. This result section will, therefore, address both themes: information on dissemination to patients or patient organisations and patient involvement in dissemination. Abstracts that met the inclusion criteria were selected for detailed, full text review. PMID: 18070335. These include uncertainty about the strength of evidence (also called ambiguity), uncertainty about the significance of particular risks (including their timing or severity), uncertainty about the complexity of information (e.g., the multiplicity or stability of risks), and uncertainty resulting from ignorance about risks. dissemination plan has been successful and to help form future plans 6. Ann Intern Med 2011 July 19;155(2):87-96. Enhance your health!” vs. “A lack of activity increases risk for diabetes.”, Negative (loss) frame: “With drug X, you have a 5% chance of dying” vs. “With drug X, you have a 95% chance of surviving.”. Studies with a medium risk of bias are those with some bias but not enough to invalidate results that do not meet all criteria required for low risk of bias. Med Decis Making 2011 Mar-Apr;31(2):354-66. Kuhn KM, Budescu DV. When different sources and tools are applied over a longer period, the dissemination can be described as most adequate because information will last longer when seen and heard more often [6]. Abma TA, Nierse C, Widdershoven GAM. Lay versions, as described above, are expected to reach individual patients. Two independent reviewers will assess the risk of bias for each study. In some cases, patient friendly decision aids may also be an adequate tool for dissemination of recommendations to patients although more research is needed to define condition where decision aids can replace or complement lay versions of recommendations. assertiveness) [38]. Health Expect. Reference: Agency for Healthcare and Research Quality. 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. The use of strategies to adopt and integrate evidence-based health interventions and change practice patterns within specific settings. She was actively involved in all steps of the review and writing of this paper. Available at. The study and use of communication strategies to inform and influence individual and community decisions that affect health. 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). 2013;144(2):381–9. BMJ Qual Saf. 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. To be most effective, dissemination strategies must be incorporated into the earliest planning stages of a research study. 2004;63:1172–6. We will sort the studies into prevention and diagnosis/treatment categories after the abstract and/or full-text review process and confer with AHRQ about the possibility of including both the prevention and diagnosis/treatment categories based on the number of studies in each category and available resources. Boulet et al. Multiple systematic reviews, however, have explicated key communication techniques that are of interest to the field such as: Several other communication techniques exist such as applying plain language principles, varying the source of the evidence, and using theoretically driven messages. PMID: 21959223. Most of the 21 papers can be described as opinion papers or papers that describe strategies that have been used or might be effective. Evidence reports and technology assessments generated through AHRQ’s EHC Program provide science-based information about common, relevant health conditions and technologies to serve the needs of patients, clinicians, insurance payers, and other end-users. 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! As described above, evidence dissemination has several broad goals. PubMed  PubMed, Ebsco/PsycInfo, Embase.com and Ebsco/Cinahl were searched on 4 February 2016, all from inception, by KS and JK. Effective Health Care: What Is the Effective Health Care Program? [ 6] and Allu et al. Guidelines should be easily searchable and accessible immediately [30, 31]. One article had a level of evidence of 2(b). Cochrane Database Syst Rev. A lack of attention to cultural differences can lead to products or programmes that do not meet the needs or possibilities of the target audience. Article  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. 2013;24(3):282–90. By evaluating the comparative effectiveness of communication techniques and dissemination strategies, this review will inform efforts to make research easily accessible for patients and clinicians. further recommend the use of familiar words of one or two syllables, the use of active voice in the present tense and the use of short sentences of 15 words or less, and short paragraphs of ten lines or less [24]. Int J Health Care Qual Assur. Scott SD, Albrecht A, O’Leary K, Ball HDC, Hartling L, Hofmeyer A, et al. What to do 1. We used the Quality Assessment Tool for Qualitative Studies to assess the methodological quality of the qualitative studies [19] (see Additional file 3). 2012 Feb;65(2):163-78. Usual care/practice for dissemination is passive dissemination— passive, uncontrolled spread of information of evidence or no spread of information. In total, we identified 47 articles that met the inclusion criteria, 43 through the SLR and 4 through the hand search. The use of internet and digital tools like websites and apps seems to be promising and necessary to reach patients [30, 31]. Grimshaw JM, Shirran L, Thomas R, Mowatt G, Fraser C, Bero L, et al. Another suggestion is the establishment of permanent groups, networks or ‘virtual panels’ of patients [38]. In this paper, Philip Scullion sets out to explore and disentangle some of these complexities, examine examples of successful dissemination strategies and … Majumdar SR, Soumerai SB. Patients who have access to lay versions are better equipped to prepare themselves for the consultation with their health care provider and are expected to become an active partner in their own treatment [6]. 1.Research. In: Methods Guide for Effectiveness and Comparative Effectiveness Reviews. 2008;17(4):296–300. O'Keefe DJ, Jensen JD. Med Care 2001 Aug;39(8 Suppl 2):II2-45. The effects of information framing on the practices of physicians. Dissemination of additional types of data, such as quality or benchmarking data, can be equally important in advancing the evidence base to support nursing interventions and optimize patient outcomes across settings. We plan to include studies that have at least one outcome of interest. A framework for improvement. How can we improve guideline use? Can J Cardiol. Rockville, MD: Agency for Healthcare Research and Quality; 2009. All authors read and approved the final manuscript. For all EPC reviews, the EPC reviewed KQs and refined them as needed with input from Key Informants and the Technical Expert Panel (TEP) to ensure that the questions are specific and explicit about what information is being reviewed. The articles are published between 2002 and 2014 but most of them are published between 2010 and 2014 (15). The intent is to spread knowledge and the associated evidence-based interventions. The EPC solicits input from Key Informants when developing questions for systematic review or when identifying high-priority research gaps and needed new research. In these cases, information about the recommendations may reach the patient from different sources with the benefit of mutual enforcement. The group followed the EULAR Standardized Operational Procedures [14] and met twice. Overall there may be net benefit, clinical equipoise (benefit that is too close to call at the population level), or net harm. If the reviewers disagree, conflicts will be resolved by discussion and consensus or by consulting a third, senior member of the review team. doi:10.1002/14651858.CD001431.pub4. Schipper K, Abma TA, van Zadelhoff E, van de Griendt J, Nierse C, Widdershoven GAM. For sustainable adaptation, more efforts are needed [29]. PMID: 11583120. Chapters available at. These communication strategies are widely used and can be considered best practices; however, they are not included in this review given our focus on comparative effectiveness of different techniques. Patient Educ Couns. However, it is not systematically investigated which strategies are feasible for the dissemination of recommendations to patients. 2015;31(3):190–6. They may include awareness about the evidence; knowledge about the evidence; discussions about the evidence; behavioral intentions to use or apply the evidence; and self-efficacy. 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. https://doi.org/10.1186/s13012-016-0447-x, DOI: https://doi.org/10.1186/s13012-016-0447-x. JABFM. These studies may have some flaws in design or execution (e.g., imbalanced recruitment, high attrition) but they provide information (say, through sensitivity analysis) to enable the reader the ability to evaluate to determine that those flaws are not likely to cause major bias. Available at. PMID: 15595944. The initial search revealed 3753 unique publications. Eular report. Knowledge brokers can also be used. Google ScholarÂ. Thesis. Improvement of health care can be enhanced by the dissemination of recommendations that are easy to find and easy to understand by patients. Training for professionals should however also get attention since professionals also have to learn how to work effectively together with patients [51]. Swedish healthcare is publicly funded and residents are insured by the state, with equal access for the population and fees regulated by law. Ke CH, Casey CG, Yu CH. de Wit MP, Berlo SE, Aanerud GJ, Aletaha D, Bijlsma JW, Croucher L, et al. Health communication is an important part of a health care organization's strategies to meet their stakeholders' needs. In the context of this review, the word guidelines and recommendations are used as synonyms. At the start, we assumed a difference between dissemination towards professionals in comparison to dissemination to patients. Table 2 summarizes the evidence for the effectiveness of the four communication techniques examined in this review: tailoring the message, targeting the message to audience segments, using narratives, and framing the message. Moderate confidence that the evidence reflects the true effect. 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. Patients have therefore limited access to information to get an adequate understanding of their disease and treatment options. Making these recommendations accessible for patients requires an extra effort from health professionals or patient organisations to translate the English version into another language and to adjust the content of the recommendations to the national context, and the specific information needs of patients without losing scientific rigor [6]. Generate a discussion on the most appropriate mode of evidence dissemination based … In contrast to AHRQ’s EPCs, the U.S. Preventive Services Task Force (USPSTF) makes specific determinations of net benefit and also includes applicability in their judgments about evidence grade. The GIN toolkit suggests (1) informing patients about their role before participating, (2) clarifying expectations about the specific role of the patients and the time commitment required, (3) giving a training in advance to prepare patients for their assigned role and (4) supporting patients during the process [38]. Dissemination is seen as playing a key role in building sustainable health and social ecosystems while supporting society. This tool leads to an overall methodological rating (strong, moderate or weak) taking important elements into account such as selection bias, study design, confounders, blinding, data collection methods, withdrawals/dropouts, intervention integrity and analysis [17]. Disabil Health. Description: Many effective programs emerging from research fail to have a significant impact on population health because no plans are made to disseminate these programs to agencies and organizations that can use them. They are selected to provide broad expertise and perspectives specific to the topic under development. J Health Commun 2001 Jan-Mar;6(1):61-82. Schipper, K., Bakker, M., De Wit, M. et al. 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. After reading the full text of the 47 articles, 21 were relevant for answering our research question. Risk Analysis1987 Dec;7(4):519-29. K. Schipper. Dissemination Strategies Evidence-based practice (EBP) is essential to improve healthcare quality and patient outcomes as well as reduce healthcare costs. For communication and dissemination, we will include studies from January 2000 to the present. Gainforth HL, Latimer-Cheung AE, Athanasopoulos P, Martin Ginis KA. Barriers and facilitators to implementing shared decision-making in clinical practice: update of a systematic review of health professionals’ perceptions. 2002;27(5):E121–7. Hinyard LJ, Kreuter MW. High-quality studies must be conducted and the body of evidence must then be synthesized and summarized, often in the form of systematic reviews. PMID: 10535437. doi:10.1136/ard.2004.023697. In particular, patient organisations can play an important role in reaching out to the patient community and to solve difficulties to reach patients. The authors of this report are responsible for its content. J Eval Clin Pract. They use various techniques to communicate evidence so that target audiences can understand it better. Patients should be encouraged to become a member of the association and receive information and other support [21]. What dissemination strategies are feasible to inform and educate patients about recommendations or guidelines? This can be done by using their own website, newsletters, brochures, other publications, phone calls, support groups, workshops, events, seminars, annual conferences, local or regional events, events for professionals and/or patients, press releases, print-ready ads, fillers or by including the recommendations in their information packages provided to their members [38]. For communication and dissemination (KQs 1 and 2), we will only include health-related evidence that seeks to promote informed decisions about individual-level human health, reflecting our general interest in prevention, diagnosis, and treatment. Participation of patients in the whole process is one of the most important findings. End-users need to understand the overall balance of benefits and harms (i.e., the “net benefit”) of preventive services and treatments. Based on international recommendations and best practices, Azevedo and colleagues [26] suggest to follow three steps for the translation and cross-cultural adaptation of guidelines: forward translation, back translation and patient testing. The relationships can be informal (friends, peers, or family) or formal (patient/provider/nurses) that have defined role obligations. Development of the RTI item bank on risk of bias and precision of observational studies. Several papers confirm that dissemination requires a combination of different, mutually reinforcing strategies (e.g. EULAR standardised operating procedures for the elaboration, evaluation, dissemination, and implementation of recommendations endorsed by the EULAR standing committees. Obtain feedback from end users. EULAR has chosen to involve patients from different countries because of the international context of the recommendations. A review protocol was developed by KS and JK, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement [15]. PMID: 8192299. Ann Rheum Dis. (2012, July 31). 10(12)-EHC063-EF. For example, an evidence developer might train/enlist the help of a local champion to promote evidence within his or her organization. Targeting can be accomplished by manipulating language, visuals, music, or choice of behavior topic that make the message more interesting, relevant, or appealing to specific subgroups. For example, in a synthesis of 41 systematic reviews, Grimshaw and colleagues16 reported that active, multifaceted approaches were most effective.16 Additional research also supports this conclusion. Results of a multinational survey among nurses rheumatologists and patients. The grades of evidence that can be assigned are defined in Table 10. The analysis of the articles showed that, besides information about dissemination to patients or patient organisations, many articles paid attention to patient involvement in dissemination. The TOO reviewed contract deliverables for adherence to contract requirements and quality. Nursing and Health Care Perspectives, 22(3), 124‐129. N = 6,679 PMID: 17592961. Both reviewers (KS and MB) conducted the analysis separately and then explored similarities and differences between the studies. Health Bucks Evaluation Toolkit pg. [7–12]). In addition, for comparative effectiveness reviews, the KQs were posted for public comment and finalized by the EPC after review of the comments. Boulet et al. The study designs were heterogeneous utilising randomised control, descriptive/case series or comparable cohort/case control study methods. Although patients are more and more involved in the development of guidelines [3, 45] (for professionals), their involvement in the dissemination process (towards patients and professionals) is still less common. Enhance expectations from funders of research for more consistent and intentional dissemination. Discrepancies were resolved by discussion, supported by two of the authors (TA and MdW). volume 11, Article number: 82 (2015) Grades reflect the strength of the body of evidence to answer the KQs on the comparative effectiveness of the interventions in this review. INTRODUCTION It is commonly recognized that research is now an activity undertaken by many health care professionals. 1998–2007, Latimer et al., 201014 The John M. Eisenberg Center for Clinical Decisions and Communications Science translates AHRQ’s comparative effectiveness review information to create a variety of materials ranging from evidence summaries to decision aids and other products. We describe the role of a data driven learning collaborative, the High Value Healthcare Collaborative (HVHC), in the dissemination of best practice using adherence to the 3-hour-bundle for sepsis care. This review also identified a significant knowledge gap regarding effective dissemination strategies: More valid and credible research has to be conducted in order to obtain higher levels of evidence for the effects, efficiency and barriers of existing dissemination strategies and the role of patient organisations in that process. The relative persuasiveness of gain-framed and loss-framed messages for encouraging disease prevention behaviors: a meta-analytic review. This might include tracking sheets to be given to patients and risk calculators to be used by clinicians. Gagliardi AR, Brouwers MC. Latimer AE, Brawley LR, Bassett RL. We will include comparisons of two or more of the included dissemination strategies head to head or, in other words, comparisons between rows. The network should in this case include members with different backgrounds. Greenhalgh T, Robert G, Macfarlane F, et al. 10(11)-EHC063-EF. Snyman M. Using the printed medium to disseminate information about psychiatric disorders. N = 20,180 Involvement of patients, not only in the dissemination of recommendation but also in the development of recommendations, is needed. Two reviewers independently assessed the methodological quality of included studies (KS, MB). Health Bucks Evaluation Toolkit pg. Hypertension: Are you and your patients up to date? By persisting the use of such language, professionals unintentionally exclude patients [50]. Develop an evaluation plan for the dissemination strategy. A concern is that such misrepresentation of patients might lead to lay versions that are not serving the wider groups of patients something that is confirmed by the study from South Africa [25]. J Transcult Nurs. Disseminating and implementing the results of back pain research in primary care. All results will be tracked in an EndNote database. PubMed  Guidelines developed for resource-rich countries are often inapplicable in resource-poor countries [35]. Adult patients and the adult public at large, Clinicians, including physicians, nurses, midlevel providers, and/or pharmacists, Targeting the message to audience segments, Using a multipronged approach with any of the communication techniques described above (e.g., tailoring and targeting), Increase reach of the evidence (e.g., telephone; postal mail/e-mail; electronic/digital media, social media, mass media; interpersonal outreach), Increase people’s motivation to use and apply the evidence (e.g., opinion leaders, champions, social networks), Increase people’s ability to use and apply the evidence (e.g., additional resources, skills building), Use a multipronged approach with any of the dissemination strategies described above (e.g., social marketing, academic detailing), Different presentation formats (e.g., graphical, numeric, non-numeric), Any communication technique, including the ones above and hypothetical situations, Behavioral intentions to use or apply the evidence, Inpatient and outpatient settings and clinics of all types, Churches, fraternal organizations, professional or social clubs, pharmacies, and homes, National Institute for Health and Clinical Excellence. Any information delivered via TV, radio, print newspapers, print magazines, or billboards. For purposes of our review, communication techniques fall into the broad area of “health communication” and focus on making evidence interpretable, persuasive, and actionable. 2010;6 Suppl 4:A10. Providing lay versions might be seen as a key component of good care [2], especially because patients increasingly want to be involved in decision-making processes [3]. health departments, researchers, policy makers, and health advocacy groups. Consider your target audience. 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. A multicomponent approach uses several communication techniques in concurrent combination or in sequence to increase the comprehension and understanding of evidence. PubMed  Strength of evidence requires a value judgment based on the risk of bias, consistency, precision, and directness of evidence (see definitions below). In the forward translation step, two professionals/patients (no translators) independently translate the original version into the target language. We will also exclude studies that compare permutations of the included communication techniques, which is comparison within the rows above as opposed to across the rows above, for the same reason. Such conditions may be associated with heterogeneity of treatment effect and the ability to generalize the effectiveness of an intervention to use in everyday practice. 2007 Sep 10-11. Dissemination is the targeted distribution of information and intervention materials to a specific public health or clinical practice audience. 20 Dissemination of Findings: How to Share Results Once the evaluation is completed, it is important to share the results and/or evaluation procedures with a variety of stakeholders. Community Mental Health Journal 36:47-60, 2000 Crossref, Google Scholar. Chest. statement and 2007;32:339–68. They could endorse the intervention, have a role in its development, or advise on strategies. Communicating the uncertainty of harms and benefits of medical interventions. It is then compared with the original and reviewed to ensure conceptual equivalence. Implementation processes to improve health outcomes are beyond the scope of this review. There is less information about the impact of the use of different strategies. Qual Saf Health Care. Implementing practice guidelines: a workshop on guidelines dissemination and implementation with a focus on asthma and COPD. Professionals reported the discrepancy between the perspectives of themselves and patients as an important barrier in the development of recommendations. Data synthesis and analysis is a core step in developing a systematic review. Duplicate articles were excluded. View more Module 6: Disseminating Best Practices Disseminating program results can help rural community health programs to build relationships with project partners and funders, increase visibility, and share best practices. We will also exclude studies that compare alternate presentations of point estimates, as these studies have been well summarized in previous reviews on risk communication.26,35-37. Prior M, Guerin M, Grimmer-Somers K. The effectiveness of clinical guideline implementation strategies—a synthesis of systematic review findings. suggest to disseminate recommendations by providing automatic updates of new information and resources for patients who have signed in, by interactive internet-based lectures and by developing a variety of learning tools like posters, summaries, handouts, pocket cards and slide sets for patients [21]. Evidence-based public health interventions, which research has demonstrated offer the most promise for improving the population’s health, are not always utilized in practice settings. Uncertainty is inherent in health and health care evidence and can limit its use. Outcomes: use of composite outcomes that mix outcomes of different significance to patients, Settings: restrictions to certain types of health care institutions when services might be rendered in many different locales or venues, and. J Public Health Manag Pract. Government agencies and institutions, advocacy groups, media organizations, researchers, and other interested stakeholders can all carry out communication activities. We will also include studies that measure ultimate outcomes. Peer Reviewers are invited to provide written comments on the draft report based on their clinical, content, or methodological expertise. Within the EPC program, the Key Informant role is to provide input into identifying the KQs for research that will inform health care decisions. At the same time, patients find it difficult to affirm their views and experience in the presence of evidence-based information and existing power asymmetries wherein expert knowledge is appreciated more than experiential knowledge [46–49]. In this paper, Philip Scullion sets out to explore and disentangle some of these complexities, examine examples of successful dissemination strategies and provide valuable insights. We will assess the applicability both of individual studies and of the body of evidence for specific KQs.38 For individual studies, we will examine characteristics that may limit applicability based on the PICOTS structure. It is therefore important to involve a diverse group of patients (age, gender, educational level, ethnicity), and for that aim, the adaptation of existing processes might be needed to make their participation possible. MB and MdW were involved in formulating the inclusion criteria, selecting the papers, assessing the levels of evidence of the papers, conducting the content analysis/data synthesis and writing this paper. (2001). 2004;7(4):15–20. Securing a long term societal, political, economic, environmental and scientific impact through dissemination efforts can lead to broader societal changes. To assess the applicability of a body of evidence, we will consider the consistency of results across studies that represent an array of different populations. In: Cochrane handbook for systematic reviews of interventions. For each outcome and, within each outcome, each comparison type, we will examine the consistency and precision of effect. After the abstract and/or full-text review process, we will review the combinations of dissemination strategies, identify the most frequent combinations, and likely focus our efforts on synthesizing and analyzing the most frequent combinations. doi:10.1136/annrheumdis-2012-eular.2416. We will qualitatively synthesize the results and determine a rating of low, medium, or high risk of bias. Second, involve patients in less traditional ways (e.g. Thousand Oaks: Sage Publications; 1995. p. 186-98. In this context, we will look at studies that attempted to explain that although research evidence may exist on a particular topic, it may not be generalizable for one or more reasons. A secondary objective was to examine how the effectiveness of communication and dissemination strategies varies across target audiences, including evidence translators, health educators, patients, and clinicians. Examining the effectiveness of a knowledge mobilization initiative for disseminating the physical activity guidelines for people with spinal cord injury. We found qualitative studies, surveys, descriptive studies, opinions, editorials and conference abstracts. These recommendations are primarily developed to inform health professionals to improve daily routines of medicine. Admissible settings include inpatient and outpatient settings and clinics of all types; academic health care institutions; and community-based settings such as churches, fraternal organizations, professional or social clubs, pharmacies, and homes. Strategies to explain the different types of uncertainty in evidence may use numeric, non-numeric, or visual presentation formats. Using analogous search terms, the librarian will also search the Cochrane Library and Cochrane Central Trials Registry for trials on these topics. Possible moderators of interest for all key questions include: risk of bias, study size, and target audience. This is analogous to a text-word search in MEDLINE. National patient organisations should, according to the GIN toolkit, disseminate the recommendations in their own countries. Lack of consistency is when studies suggest different effect sizes (have a different sign) or completely different (i.e., conflicting) effects or affects where the size of the effect is appreciably different. NIH Program Announcement for Dissemination and Implementation Research in Health (R01) external icon (NIH 2009) AHRQ Best Practices in Public Reporting No. Probability information in risk communication: a review of the research literature. Here, careful consideration should be given to social and cultural sensitivities and differences like hierarchal culture, working according to plans or not [34], or the presence of certain professionals (for example specialised nurses) or health resources [34]. Dannapfel P, Poksinska B, Thomas K. PURPOSE: The purpose of this paper is to contribute to knowledge about dissemination strategies for Lean thinking throughout multiple healthcare … Dissemination of research findings or other key messages is increasingly acknowledged as a vital yet complex process. The search gives insight in three main factors that may make the dissemination of recommendations towards patients more successful. It is argued that the process of dissemination needs to be afforded greater emphasis by project-funding bodies, research supervisors, researchers, and those responsible for implementing … Update on the methods of the U.S. Preventive Services Task Force: estimating certainty and magnitude of net benefit. Tailored communication delivered via print or the Internet is more effective than nontailored communication in increasing knowledge and changing behavior. Based on a survey among professionals, McGuire et al. Springer Nature. 2008;73(3):526–35. 2008;14:888–97. Support Care Cancer. End-users also need to grasp whether the evidence is applicable for their own unique populations and settings. The hand search and grey literature resulted in four relevant articles. 2014;53(8):1491–6. This systematic literature review (SLR) followed the process recommended by the Centre of Reviews and Dissemination [13]. Peer review comments on the preliminary draft of the report are considered by the EPC in preparation of preparing the final draft of the report. A successful lay version provides clear, explicit and specific information [6, 23] and some key messages [2]. Dissemination workplan‐provides a framework for organizing your strategy. These can be the following: for patients—health-related decisions or behavior and clinical outcomes; and for clinicians—behavior. The selection of patients may be challenging. 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. AHRQ sponsors research to improve the quality, effectiveness, and safety of health care in the United States. Assessing applicability requires considering whether the preventive service or treatment tested would be expected to have the same biologic effect in the population and setting in which it might be applied. PMID: 8192299. Health Educ Behav 2007 Oct;34(5):777-92. Methods Guide for Effectiveness and Comparative Effectiveness Reviews. When the overall strength of evidence is high, the uncertainty is low. We distinguish dissemination strategies from implementation strategies, with the latter focusing on actually undertaking the process to institutionalize the new evidence in clinical practice. Health Expect 2013; 2013/02/01 doi: 10.1111/hex.12048. 2011;31:E45–74. Implement Sci. PMID: 19595577. Snyman’s study shows that strategies to disseminate lay versions need to be accompanied by the development of other materials. Allergy, sthma Clin Immunol. For this reason, the results of this review should not only be handled with care, it should also encourage researchers to initiate evaluation studies that will provide knowledge about the effectiveness of dissemination strategies with higher levels of evidence. For instance, Han et al.26 identified several relevant domains of uncertainty that influence health care. Dissemination strategies aim to spread knowledge and the associated evidence-based interventions on a wide scale within or across geographic locations, practice settings, or social or other networks of end-users such as patients and health care providers. 2010. doi:10.1111/j.1369-7625.2010.00647.x. Despite the numerous advances made in clinical and public health research over the past few decades, discontinuity still exists in the process of disseminating and implementing research discoveries into practice settings [1–3].The dissemination and implementation of these discoveries are important in working towards improving the population’s health [4, 5]. Statistical analysis, including adjustment for multiple comparisons, clustering, and use of intention-to-treat analysis, Results in intervention and control groups, Literacy/numeracy level of audience intervention intensity and/or complexity, Format of presentation (graphical, numeric, non-numeric, combination). The idea here is that an opinion leader is endorsing the idea being disseminated. In examining influences that help spread innovations along the continuum between passive diffusion of information and active dissemination, Greenhalgh et al.15 created an inventory of strategies aimed at influencing individual, social, and other networks of adopters. Transforming scientific evidence for its use in practice, commonly known as research translation, involves many processes and strategies. Below we describe the population, intervention, comparators, outcomes, and settings (PICOTS) for our review (see Table 3). A hand search and a search in the grey literature, also done in February 2016, were added. Prim Care Respir. PMID: 18087058. Légaré F, Ratté S, Gravel K, Graham ID. While maximizing dissemination and implementation is still an issue, considerable progress in the field of dissemination and implementation science had been made in the past quarter century. Particularly relevant for the dissemination of evidence-based health promotion practices are those of Greenhalgh et al (6) and Wandersman et al (7). One way to empower patients to make more informed choices is the development and dissemination of patient or lay versions of the recommendations. This review shows that dissemination towards patients does not differ when it comes to the need to make a plan before or at the start of the project. We will not examine interventions designed to help individuals cope with uncertainty. The toolkit is the result of a series of consultations, a literature review and the practice and experience of the GIN members [38]. Dissemination strategies—defined as the development and targeted distribution of messages and materials about research evidence pertaining to a specific issue or intervention—can help address these challenges. Various ways of communicating uncertainty-associated health-related evidence to different target audiences (KQ 3). In the sections below, we present background information for the three areas of the review—communication techniques, dissemination strategies, and communicating uncertainty. Strategies for disseminating recommendations or guidelines to patients: a systematic review. The main objective of dissemination is to increase and promote the spread of knowledge regarding evidence based interventions, with an intention of enhancing its greater application and patient outcomes (Cain & Mittman, 2012). • Supports dissemination of evidence-based strategies to improve health • Research conducted at UW-Madison or Marshfield • Supports activities such as: • Targeted distribution of research findings , products or materials to a specific audience • Development of materials in preparation for dissemination and/or implementation activities Success in one country does not guarantee success in other countries [34], or even within countries if there are significant cultural differences within countries. Individualized feedback may have then been provided synchronously (e.g., via chat, telephone, or face to face) or asynchronously (e.g., via e-mail or a discussion board or by postal mail). Choosing segmentation strategies and methods for health communication. In fact, the most successful dissemination processes are typically designed prior to the start of The decision will be based on the total number of studies and, assuming a sufficient number of studies are potential candidates for such analyses, on an assessment of both the clinical and the statistical heterogeneity of the data. The GIN toolkit suggests that the translation of the English lay version in different languages should be done by patient organisations, using a heterogeneous group of patients with different disease status and educational levels [38]. Invited Peer Reviewers may not have any financial conflict of interest greater than $10,000. Biological Research for … Social networks, such as a network of individuals who are friends, colleagues, or know each other. Using such a PAR design may, according to the authors, result in culturally appropriate brochures for patients [39]. Dissemination strategies aim to spread knowledge and the associated evidence-based interventions on a wide scale within or across geographic locations, practice settings, or social or other networks of end- users such as patients and health care providers. dissemination strategy in healthcare. Dissemination is an essential component of the quality improvement cycle, ensuring the best available evidence is incorporated into … 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. Clin Transl Sci 2011 Jun;4(3):188-98. Although the findings of our study regarding the value of a multifaceted and active strategies are much in line with studies on dissemination towards professionals [43, 44], the applied tools and methods are different. Net benefit describes the balance or trade-offs in benefits and harms for prevention or treatment services. Furthermore, the information in the recommendations should be consistent, unambiguous and credible [6]. The third suggestion is training: provide patients with sufficient information and knowledge before and during the project. This project was funded under Contract No. ORIGINALITY/VALUE: There are many case studies describing Lean implementation in single healthcare organisations, but little is known about effective dissemination and implementation strategies in large healthcare systems. For studies without adequate information to determine inclusion or exclusion, we will retrieve the full text and then make the determination. 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. A 10-year systematic review of HIV/AIDS mass communication campaigns: have we made progress? Through July 2008. 2014;27(5):391-404. Patients should be involved from an ethical point of view: involvement is needed to give patients influence on the recommendations by incorporating their experiential knowledge and perspectives. INTRODUCTION It is commonly recognized that research is now an activity undertaken by many health care professionals. Effect sizes can vary based on length of followup, variables tailored, type of behavior, population studied (general vs. chronic illness), and number of intervention contacts. doi:10.1111/j.1365-2753.2008.01014.x.a. After the abstract and/or full-text review process, we will review the combinations of communication techniques, identify the most frequent combinations, and likely focus our efforts on synthesizing and analyzing the most frequent combinations. NIH Conference. The research team then synthesised and interpreted the evidence as it related to the purpose and aims of the review. Health Communication and Dissemination. Ten adult patients are given the translated version and are interviewed about the interpretation and wording of each item. The settings must be countries located in Blocks 1 or 2 based on a recent world-system analysis by Kick et al. Sharpe PA, Brandt HM, McCree DH, Owl-Myers E, Taylor B, Mullins G. Development of culturally tailored educational brochures on HPV and Pap tests for American Indian women. PMID: 21707950. Findings from clinical, health services, and comparative effectiveness studies—especially as assembled for systematic reviews and similar documents—need to be communicated and disseminated effectively to influence optimal and timely practice and health policies.30, Because systematic reviews evaluate multiple studies, they are inherently complex. The following terms were used (including synonyms and closely related words) as index terms or free-text words: ‘guidelines’ or ‘recommendations’ and ‘dissemination’ and ‘patients’ or ‘consumers’. Second, the original recommendations, often developed by and for professionals, need translation into a readable lay version for patients [6]. Steginga SK, Occhipinti S. Decision making about treatment of hypothetical prostate cancer: is deferring a decision an expert-opinion heuristic? Peer Reviewers who disclose potential business or professional conflicts of interest may submit comments on draft reports through the public comment mechanism. PubMed Google Scholar. Vol 4. There are various internal and external methods of disseminating evidence based project. J Clin Epidemiol. Transforming healthcare organizations into a setting where an EBP culture exists requires persistence, patience, and perseverance (Melnyk &Fineout-Overholt,2018). Dissemination strategy for Lean thinking in health care. 2011;70(5):722–6. Explaining such findings and their implications can be challenging. The full search strategies for all databases can be found in Additional file 1. Stakeholder Analysis The dissemination strategy should be based on an understanding of Coupled with these mandates is the fact that the ad hoc Uncertainty Committee of the EHC Stakeholder Group is interested in promoting effective ways to communicate uncertainty about health and health care evidence to end-users. AHRQ is seeking nominations of promising patient-centered outcomes research (PCOR) findings with the potential to improve patient health outcomes for future dissemination and implementation activities.. PCOR compares the impact of two or more preventive, diagnostic, treatment, or health care delivery approaches on health outcomes, including those that are …