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Interventions in Organizational and Community Context: A Framework for Building Evidence on Dissemination and Implementation in Health Services Research

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Abstract

The effective dissemination and implementation of evidence-based health interventions within community settings is an important cornerstone to expanding the availability of quality health and mental health services. Yet it has proven a challenging task for both research and community stakeholders. This paper presents the current framework developed by the UCLA/RAND NIMH Center to address this research-to-practice gap by: (1) providing a theoretically-grounded understanding of the multi-layered nature of community and healthcare contexts and the mechanisms by which new practices and programs diffuse within these settings; (2) distinguishing among key components of the diffusion process—including contextual factors, adoption, implementation, and sustainment of interventions—showing how evaluation of each is necessary to explain the course of dissemination and outcomes for individual and organizational stakeholders; (3) facilitating the identification of new strategies for adapting, disseminating, and implementing relatively complex, evidence-based healthcare and improvement interventions, particularly using a community-based, participatory approach; and (4) enhancing the ability to meaningfully generalize findings across varied interventions and settings to build an evidence base on successful dissemination and implementation strategies.

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Acknowledgments

This article was prepared under the auspices of the UCLA/RAND NIMH Center for Research on Quality in Managed Care and supported by funding from the National Institute of Mental Health, Grants# P30 MH068639 and P50 MH054623 (Wells, PI), the Robert Wood Johnson Foundation #038273 (Wells, PI), and the NIH National Center on Minority Health and Health Disparities #1P20MD00182-01 (Norris, PI). The authors would like to thank the participants of the NIMH Conference on Advancing the Science of Implementation, David Chambers of NIMH, and the anonymous reviewers for their insights and comments on earlier versions of this paper.

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Authors and Affiliations

  1. RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA

    Peter Mendel, Lisa S. Meredith, Michael Schoenbaum, Cathy D. Sherbourne & Kenneth B. Wells

  2. UCLA-Semel Institute, Health Services Research Center, 10920 Wilshire Blvd., Suite 300, Los Angeles, CA, 90095, USA

    Kenneth B. Wells

  3. NIMH Division of Services and Intervention Research, 6001 Executive Blvd, Room 7142 MSC 9629, Bethesda, MD, 20892-9669, USA

    Michael Schoenbaum

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  1. Peter Mendel
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  2. Lisa S. Meredith
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  3. Michael Schoenbaum
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  4. Cathy D. Sherbourne
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  5. Kenneth B. Wells
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Correspondence to Peter Mendel.

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Mendel, P., Meredith, L.S., Schoenbaum, M. et al. Interventions in Organizational and Community Context: A Framework for Building Evidence on Dissemination and Implementation in Health Services Research. Adm Policy Ment Health 35, 21–37 (2008). https://doi.org/10.1007/s10488-007-0144-9

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