Effective dissemination: An examination of theories and models of change for research dissemination in the AOD field.

This document is Part Three of a 3-part series by the National Centre for Education and Training on Addiction (NCETA) examining effectiveness, costs and theories related to dissemination and implementation of research into practice. Part One in the series is a systematic review that evaluated the effectiveness of 16 different dissemination strategies for implementing new research, programs and treatments into practice in alcohol- and other drug-related areas (Bywood, Lunnay & Roche, 2008a). Part Two is an examination of the costs associated with using such strategies (Bywood, Lunnay & Roche, 2008b). In this part (Part Three), the theories and models of change underpinning the use of dissemination strategies and the implications for the alcohol and other drugs (AOD) field are examined. This report provides a summary of key theories and models that have been used in the development of dissemination strategies for facilitating uptake of innovations into practice, or to interpret the outcomes of an evaluation of such strategies. Studies that were included in Part One were examined for any reference to theories, theoretical frameworks or models of behavioural and organisational change. A description of the identified theories and models of change is outlined and findings from relevant studies are summarised in the current report. Finally, some common elements across the different theories were identified, and the key dissemination theories and models are discussed in terms of their relevance for getting effective innovations implemented in the AOD. Theories are classified into five broad types: â? ¢ Learning theories â? ¢ Motivational theories â? ¢ Stage models â? ¢ Process or planning models â? ¢ Ecological or organisational change theories. Theories and models, which focus on either the individual practitioner and/or the organisation as the unit of change, may address change at different levels, including: â? ¢ Intrapersonal: Theories or models that attempt to explain or predict change in an individualâ? Ts attitudes, knowledge, behaviour or intentions to act â? ¢ Interpersonal: Theories or models that attempt to explain or predict change in the way individuals act in the context or their social environment â? ¢ Ecological / Organisational: Theories or models that attempt to explain or predict change at the level of the organisation or wider social system. No single theory or model accounted for all possible variables that might contribute to behaviour change and not all theories were useful in all circumstances. Thus, the use of multiple theories to change complex human behaviours may be needed. However, there were several theoretical elements that were common to multiple theories and may contribute to a change in practice. These common elements were: â? ¢ Perceived control over behaviour (self-efficacy) â? ¢ Perceived outcomes of behaviour (expectancy) â? ¢ Motivation Intention to act â? ¢ Positive attitude â? ¢ Personal values â? ¢ Affect â? ¢ Role of social influences (perceived norms) â? ¢ Environmental barriers â? ¢ Professional development (training) One example of a framework for developing dissemination and implementation strategies is described. This framework identified and integrated theoretical constructs that are relevant to changing professional practice across multiple levels. The six key elements were: 1. Identify the problem or need to change 2. Examine the current context 3. Consider the relevant theoretical constructs 4. Develop a strategy 5. Implement change 6. Evaluate the process, seek feedback and maintain change. Incorporating these elements into dissemination strategies may increase the potential for effective implementation of innovations into practice or for interpreting findings and refining strategies for specific situations, populations or target behaviours. Thus limited resources can be allocated to effective dissemination strategies with a higher probability of success.