Relevance for Public Health

Although this method was developed for clinical health services, this approach would also be useful for disseminating and implementing innovative public health programs. Because conducting a field test is a crucial component, this model may be particularly relevant for public health programs that need to be adapted to the local context and that require considerable buy-in from frontline staff. For example, setting up and operating a healthy sexuality clinic for youth where specific services are tailored to the needs of local youth with input from staff could potentially benefit from strategies used in this method.

Description

This method uses a case study to describe a knowledge dissemination model based on social marketing and diffusion theory principles. This approach looks to bridge the evidence-practice gap to increase the use of research findings in clinical practice. The steps in the process help to tailor the innovation to facilitate implementation.   

The steps used include conducting focus groups with target systems (practitioners and program managers) and communities to assess program relevancy, and field testing the innovation to adapt it before full program dissemination and implementation.

The dissemination model is based on social marketing, which involves applying commercial marketing and advertising methods to promote non-commercial services, ideas or products for the public good. There are four stages in social marketing:

• Market analysis involves identifying the needs, characteristics and boundaries of the target audience.
• Market segmentation subdivides the target group using relevant characteristics to help tailor the dissemination strategy to their specific needs.
• Market strategy involves developing and implementing a dissemination plan where the product characteristics and communication strategies are appropriate for the target audience.
• Evaluation involves soliciting structured, formalized feedback about the social marketing process from the target group.

The developers of this method also draw on diffusion of innovations theory (Rogers 1983). In this theory, an innovation is communicated over time through channels by members within an organization. The decision to adopt an innovation moves through various stages, from knowledge (having an awareness of the innovation), to persuasion (forming attitudes about the innovation) and making a decision (to adopt or reject the innovation), to implementation and confirmation (seeking approval for sustaining implementation).

This method identifies five steps for knowledge dissemination:

1) Assess market opportunities and identify the target system.

2) Engage the target system.

3) Field test the intervention.

4) Disseminate and implement the innovation.

5) Gather system feedback and provide ongoing consultation.

Different roles with varying authority and responsibilities are involved at various stages of planning and implementing this dissemination method. Potential participants include program developers, program managers and community and advisory groups (e.g., government agencies, health care consumers, funding agencies, non-government organizations).

Depending on the type of innovation being disseminated, this method may be an ongoing process. With this case study, applying the method in full took three years to complete. The field-test component of the model required a year, and was particularly time-intensive.

1) Assess market opportunities and identify the target system.

• Establish an advisory committee to identify the target system and facilitate access to relevant target agencies. Ideally, the committee will identify target agencies where the innovation is ideally suited (representing a good organizational fit) and will have the greatest impact.
• Conduct focus groups with practitioners to determine the perceived need for the innovation in the community and to identify relevant target agencies for dissemination and implementation.

2) Engage the target system.

• Identify and partner with key stakeholders and opinion leaders in the selected target agencies.
• Use a consultative approach to foster credibility with respect to competence (technical knowledge and expertise) and safety (trustworthiness and lack of a hidden agenda) with management and staff at target agencies.

3) Field test the intervention.

• Pilot test the intervention in target agencies that meet selection criteria (p. 1708 of the method).
• Develop a training plan to facilitate pilot testing.
• Assess intervention effectiveness through evaluation of field test sites.
• Make changes to the intervention based on evaluation data.

4) Disseminate and implement the innovation.

• Disseminate the intervention and provide support for implementation.

5) Gather system feedback and provide ongoing consultation.

• Monitor innovation implementation.
• Disseminate evaluation findings as a way to share learning and build on successes.
• Identify opportunities to assist in transforming the intervention into routine practice.

Marilyn Herie, PhD, RSW
Director, TEACH Project
Advanced Practice Clinician, Concurrent Disorders
Centre for Addiction and Mental Health

Adjunct Professor
Factor-Inwentash Faculty of Social Work
University of Toronto

175 College Street West
Toronto, Ontario  M5T 1P7
Tel: (416) 535-8501 x7434
Fax: (416) 599-3802
marilyn_herie@camh.net

www.teachproject.ca

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Copyright © 1998 Society for the Study of Addiction to Alcohol and Other Drugs

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