Use these tools to find what you need:. The Quality Enhancement Research Initiative QUERI Implementation cyber seminar includes discussion of: 1 implementation research frameworks, theories, and models; 2 how to diagnose a gap and design an intervention; 3 methods used in implementing research into practice; 4 formative evaluation; and 5 tools for implementation.
The Enhancing Implementation Science EIS cyber seminar presentation slides, audio, and transcript available for download highlights the important role of theory in implementation research. Guidelines for applying theory are presented, along with example studies.
Also introduces different types of theories and models, and guidelines for selecting and using theoretical frameworks. Skill training, capacity building, and problem solving including training in any skill that would allow appropriate use of evidence to overcome barriers ; might include training in recognizing the quality of evidence or the circumstances under which it can be reasonably used; and also includes training in various counseling techniques that would facilitate evidence implementation and interactive seminars.
Table 7. Included components of uncertainty in an entire body of evidence and study-specific uncertainty KQ 3 Component Description Sources: Owens et al. Overall strength of evidence 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.
Strength of evidence requires a value judgment based on the risk of bias, consistency, precision, and directness of evidence see definitions below.
Risk of bias The risk of bias is the degree to which individual studies are protected from systematic errors or bias. Biases may result from study design, study conduct, or confounding by other external variables. Consistency The consistency of a body of evidence reflects the degree to which studies present similar findings—in both direction and magnitude of effect. Evidence lacking consistency includes studies with greatly differing or conflicting effect estimates.
Lack of consistency is when studies suggest different effect sizes have a different sign or completely different i. Precision 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.
Directness Directness is the degree to which the evidence links the interventions directly to the question of interest. For instance, evidence on the benefits of screening is often not directly available i.
Therefore, recommendations about screening are derived indirectly from evidence that a preclinical disease can be detected and that there is benefit in treating that same disease once symptomatic.
Net benefit Net benefit describes the balance or trade-offs in benefits and harms for prevention or treatment services. Net benefit is based on a judgment call by policymakers. Overall there may be net benefit, clinical equipoise benefit that is too close to call at the population level , or net harm.
Applicability Applicability reflects whether an intervention is expected to have the same effect in the population in which it will be used as compared with the effect in the population in which it was studied.
Table 8. Data Abstraction and Data Management For studies that meet inclusion criteria, we will abstract relevant information into evidence tables. Table 9. Data Synthesis Data synthesis and analysis is a core step in developing a systematic review. Table Definitions of the grades of overall strength of evidence Grade Definition Source: Owens et al.
Further research is very unlikely to change our confidence in the estimate of effect. Moderate Moderate confidence that the evidence reflects the true effect. Further research may change our confidence in the estimate of the effect and may change the estimate. Low Low confidence that the evidence reflects the true effect. Further research is likely to change our confidence in the estimate of the effect and is likely to change the estimate. Insufficient Evidence either is unavailable or does not permit estimation of an effect.
Assessing Applicability We will assess the applicability both of individual studies and of the body of evidence for specific KQs. Examples include the following: Population: narrow eligibility criteria, 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 Timing: studies of different duration that may have various implications for applicability.
References Agency for Healthcare Research and Quality. Rockville, MD: U. Department of Health and Human Services; Accessed March 29, Institute of Medicine. Initial priorities for comparative effectiveness research. Available at www. Accessed April 5, Lomas J. Diffusion, dissemination, and implementation: who should do what? PMID: National Institutes of Health. NIH Conference. Accessed February 21, Does tailoring matter? Meta-analytic review of tailored print health behavior change interventions.
Psychol Bull Jul; 4 A meta-analysis of web-delivered, tailored health behavior change interventions. J Health Commun ; in press. Slater MD. Choosing segmentation strategies and methods for health communication. Designing health messages. Thousand Oaks: Sage Publications; J Health Commun Jan-Feb;14 1 Using narrative communication as a tool for health behavior change: a conceptual, theoretical, and empirical overview.
Health Educ Behav Oct;34 5 Does narrative information bias individual's decision making? A systematic review. Soc Sci Med Dec;67 12 The relative persuasiveness of gain-framed and loss-framed messages for encouraging disease prevention behaviors: a meta-analytic review. J Health Commun Oct-Nov;12 7 A systematic review of three approaches for constructing physical activity messages: what messages work and what improvements are needed?
Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Q ;82 4 Changing provider behavior: an overview of systematic reviews of interventions. Why most interventions to improve physician prescribing do not seem to work. CMAJ Jul 8; 1 The effects of information framing on the practices of physicians.
J Gen Intern Med. Presenting risk information—a review of the effects of "framing" and other manipulations on patient outcomes. J Health Commun Jan-Mar;6 1 Describing treatment effects to patients.
J Gen Intern Med Nov;18 11 Covey J. A meta-analysis of the effects of presenting treatment benefits in different formats. Med Decis Making Sep-Oct;27 5 Probability information in risk communication: a review of the research literature. Risk Anal Feb;29 2 A test of numeric formats for communicating risk probabilities. Med Decis Making May-Jun;28 3 Woloshin S, Schwartz LM.
Ann Intern Med July 19; 2 Communicating treatment risk reduction to people with low numeracy skills: a cross-culturalcComparison.
Am J Public Health Dec;99 12 Communication of uncertainty regarding individualized cancer risk estimates: effects and influential factors. Med Decis Making Mar-Apr;31 2 Grading the strength of a body of evidence when comparing medical interventions. Update on the methods of the U.
Preventive Services Task Force: estimating certainty and magnitude of net benefit. Ann Intern Med Dec 18; 12 Communicating the uncertainty of harms and benefits of medical interventions.
A CTSA agenda to advance methods for comparative effectiveness research. Clin Transl Sci Jun;4 3 Smith C. The role of health professionals in informing cancer patients: findings from The Teamwork Project phase one. Health Expect Sep;3 3 Knowledge transfer and exchange: review and synthesis of the literature. Milbank Q Dec;85 4 Why don't physicians follow clinical practice guidelines?
A framework for improvement. JAMA Oct 20; 15 A multiple-network analysis of the World System of Nations, In: Scott J and Carrington P, eds. Sage handbook of social network analysis. The relative importance of probabilities, outcomes, and vagueness in hazard risk decisions. Ibrekk H, Morgan GM. Graphical communication of uncertain quantities to nontechnical people.
Risk Analysis Dec;7 4 Steginga SK, Occhipinti S. Decision making about treatment of hypothetical prostate cancer: is deferring a decision an expert-opinion heuristic? J Psychosoc Oncol ; Chapters available at www. Viswanathan M, Berkman ND. Development of the RTI item bank on risk of bias and precision of observational studies.
J Clin Epidemiol. Assessing risk of bias in included studies. In: Cochrane handbook for systematic reviews of interventions. J Clin Epidemiol May;63 5 Definition of Terms See Section I. Summary of Protocol Amendments Not applicable. Key Informants Key Informants are the end-users of research, including patients and caregivers, practicing clinicians, relevant professional and consumer organizations, purchasers of health care, and others with experience in making health care decisions.
Technical Experts Technical experts constitute a multidisciplinary group of clinical, content, and methodological experts who provide input regarding methodological issues and scoping the reviews.
Peer Reviewers Peer Reviewers are invited to provide written comments on the draft report based on their clinical, content, or methodological expertise. Role of the Funder This project was funded under Contract No.
Research Protocol Archived. Systematic Review Archived. Page last reviewed December Back to Top. The study and use of communication strategies to inform and influence individual and community decisions that affect health. The targeted distribution of information and intervention materials to a specific public health or clinical practice audience. The use of strategies to adopt and integrate evidence-based health interventions and change practice patterns within specific settings.
Noar et al. Tailored communication delivered via print or the Internet is more effective than nontailored communication in increasing knowledge and changing behavior. Communication that is targeted to audience segments is a strategy used to make information more relevant based on group membership characteristics.
Narrative forms of communication increase information processing and increase the persuasiveness of messages; people become transported into a situation that can enhance emotions, attitudes, and behaviors.
Messages framed as emphasizing the benefits of preventive action are significantly better than loss-framed messages, although the difference is small. Specific clinical interventions are described below.
Specific outcomes are described below Intermediate outcomes for all target audiences Awareness of the evidence Knowledge about the evidence Discussions about the evidence Self-efficacy to use the evidence Behavioral intentions to use or apply the evidence Ultimate outcomes for patients: Health-related decisions or behaviors Clinical outcomes Ultimate outcomes for clinicians: Behavior.
Clinical or community settings in the United States, such as: Inpatient and outpatient settings and clinics of all types Academic health care institutions Churches, fraternal organizations, professional or social clubs, pharmacies, and homes. Individual randomized controlled trials Clustered randomized controlled trials Quasi-experimental trials KQ 3 only Nonrandomized trials KQ 3 only.
Systematic reviews Meta-analyses Protocols Studies published only as abstracts Studies with no original data i. Comparisons with usual practice except for KQ 3 when the evidence is sparse. This revolutionary course engages participants in moving products out of the lab and into the market by talking to potential customers, partners, and competitors and encountering the challenges and uncertainty of creating successful innovations. U24 Program Useful resources for those interested in applying to the U24 program.
Kari Ashmont, Ph.
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