Picking and Applying a Dissemination & Implementation Science Theory Paul A. Estabrooks, PhD Twitter: @paul_estabrooks Email: paul.estabrooks@unmc.edu Dr. Paul Estabrooks - 540-857-6664

Not Everything is a Theory present a systematic way of understanding events or behaviors by providing inter-related concepts, definitions, and propositions that explain or predict events by specifying relationships among variables. are strategic or action-planning models that provide a systematic way to develop, manage, and evaluate interventions. is used to describe theories and frameworks collectively. Theories Frameworks Models Tabak RG et al. Bridging Research and Practice: Models for Dissemination and Implementation Research Am J Prev Med, 2012, 43: 337-350;

Model Categories https://www.cdc.gov/prc/stories-prevention-research/stories/dissemination-and-implementation.htm

www.dissemination-implementation.org www.re-aim.org Mode www.dissemination-implementation.org www.re-aim.org

Meta Theory Explanatory Theory Process Model Explanatory Theory Outcome Model

Do you really need an explanatory theory, process model, and outcome model? No! Most successful grants you a single conceptual model—that may or may not be an explanatory theory Those that do use a theory are more successful. The key is to define and outline both your independent and dependent variables—often easier to do and explain when using a theory and an outcome model

Why do you need a theory? To test hypotheses and contribute to the generalizable knowledge Provides pathways for intervention development Opportunities to determine underlying mechanisms of systems change Provides pathways to examine contextual moderators It explains why what happened, happened

An example against just relying on intuition

What if it is a practical idea or comes from a good community or clinical health professional—and there isn’t a theory? Work with your community or clinical partner to determine why they believe the new approach will work better than the existing approaches Search for a theoretical model that aligns with the proposed causal mechanisms Adapt the model to fit the context—always provide a rationale for adaptation and how the adaptation improves the theory for the new context

When should you choose a theory? Theory selection should be done before extensive planning or action is taken Integrated in Aims Scientific Premise Rigor and Reproducibility Approach Measures-qualitative, quantitative, or mixed-methods

Selecting and Applying Theory: Where to start? What is the outcome you are wanting to achieve? (where is that evidence-practice gap) What theory might you use to explain why changes in your outcome occurred? Glasgow, Vogt & Boles. Am J Public Health. 1999 Sep;89(9):1322-7

Feldstein and Glasgow, The Joint Commission Journal on Quality and Patient Safety 2008;34(4):228-243.

What is the outcome you are wanting to achieve What is the outcome you are wanting to achieve? (where is that evidence-practice gap) A dual purpose—that research on reducing health disparities conducted within the African American community will (1) have the potential to impact the community in a meaningful way, and (2) move science forward in a way that other communities could benefit from the work that we do. The overarching community goal is to refine, implement, and sustain a scalable technology-supported multicomponent coaching or intervention to reduce weight. The overarching scientific goal is to determine if a behavioral economics approach tailored to African American preferences can improve reach and reduce the evidence and practice gap in obesity treatment that contributes to disparities in obesity.

Aim 1. To determine if reach beyond initial program enrollment is improved by providing participant choice in incentive type Hypothesis 1-Participant choice will improve sustained reach in black participants Hypothesis 2-Black participants will perceive the program to have stronger relative advantage than participants from other racial groups Hypothesis 3-The perception of community organizational leaders, managers, and staff will vary based upon the reach of the intervention into the subgroups of the community the organization primarily serves

Aim 2. To determine the longer-term potential for intervention sustainability within the community. Hypothesis 1-Sustainability perceptions will be stronger when organizational and community infrastructure is identified to complete program implementation tasks. Hypothesis 2-Organizations with representation across leadership, managers, and staff in intervention planning and implementation will have stronger perceptions of sustainability potential. Hypothesis 3-The higher the perceived reach of the intervention into the African American population, the stronger the perceptions of sustainability need and potential. **Remember Exploratory aims to provide descriptive information on areas of a theory you may not cover in the primary aims.

Scientific Premise Gap in understanding community organization perceptions of intervention implementation and sustainability Behavioral economics successful in weight loss, but there is a lack of examination of improving initial reach after an enrollment or introductory session Systems-level approaches are recommended but few examine the underlying infrastructure and level of engagement across vertical systems as a predictor of potential sustainability.

Rigor and Reproducibility Use or adapt existing measures of implementation and sustainability infrastructure Use or adapt existing measures of prospective and ongoing intervention participants participants to determine perceptions of relative advantage related to the overall intervention and incentive structure. To provide transparency and allow for replication, all community partner organizations will be assessed for implementation climate, perceptions of fit of the intervention with organizational values, and clarity and acceptance of their roles in implementation and sustainability.

Approach Implementation and sustainability infrastructure will be measured using an adapted version of Sustainable Community Activity through Garden Education Sustainability Infrastructure tool which was developed to assess multiple organizational levels related to capacity for sustained implementation of community programs. This tool was developed to allow for adaptation to determine sustainability infrastructure of different community-based health promotion interventions.

Approach A mixed method approach of multi-leveled organizational and participant perspectives of the intervention will include validated measures of relative advantage, compatibility, ease of implementation/use as well as qualitative key informant interviews for organizational representatives and focus groups of potential and current intervention participants. Example adaptations of the measures for each organizational level and potential/current program participants are provided in Table 5. Be sure analytic section includes info to test all hypotheses proposed.

Measurement Resources

Measurement Resources

www.dissemination-implementation.org www.re-aim.org Mode www.dissemination-implementation.org www.re-aim.org

Quick Summary It’s important to have a theory to drive your research questions and projects. This was a really quick example of how a theory may be applied based upon the outcomes of interest. There is no one ‘right’ theory or model. It is very difficult to get a good score on a proposal without an overarching theoretical or conceptual approach. Applying the theory across sections of the proposal will allow you to see gaps in what you are doing… and will give reviewers a sense you have thought through the challenges of applying the theory (not just lip service). Measurement is really important and is an area you can gain innovation.