Summary Implementation and Evaluation 2019,
HEP4205
Case 1 10,000 Steps to go
Diffusion: Diffusion is the passive, untargeted, unplanned, and uncontrolled spread of new
interventions. For example: creating a website without spreading.
Dissemination: Dissemination is an active approach of spreading evidence-based interventions to
the target audience via determined channels using planned strategies
Dissemination strategy: Dissemination strategies describe mechanisms and approaches that are
used to communicate and spread information about interventions to targeted users.
Adoption: A decision of an individual or organization to use and implement a new idea (or to study
the consequences of innovation). There are specific active things they need to do.
Implementation: Implementation occurs when an individual (or other decision-making unit) puts an
innovation into use.
Implementation strategy: Systematic processes, activities, and resources that are used to integrate
interventions into usual settings.
The term innovation can refer to “an idea, practice, or object that is perceived as new by an
individual or other unit of adoption.” Some authors use this term interchangeably with the term
evidence-based intervention.
Institutionalization: Eventually a point is reached at which the new idea becomes an institutionalized
and regularized part of the adopter's ongoing operations. The innovation finally loses its distinctive
quality as the separate identity of the new idea disappears. This point is usually considered the end
of the implementation stage and is often referred to as routinization or institutionalization.
It is basically the integration in the culture and into policy, it doesn’t feel like an innovation
anymore.
Similar terms: Maintenance, sustainability
Sustainability: Sustainability describes the extent to which an evidence-based intervention can
deliver its intended benefits over an extended period of time.
Three operational indicators of sustainability are: (1) maintenance of a program’s initial health
benefits, (2) institutionalization of the program in a setting or community, and (3) capacity building in
the recipient setting or community.
Rabin et al. distinguishes 3 stages of institutionalization
1) Passage: A single event such as transition from temporary to permanent funding
2) Cycle of routine: Repetitive reinforcement of the importance of the community procedures
and behaviors, such as the annual budget and evaluation criteria
3) Niche saturation: The extent to which an EBI is integrated into all subsystems of an
organization
,
, The RE-AIM framework (Glagow)
RE-AIM provides a framework for determining what programs are worth sustained investment and
for identifying those that work in real-world environments. RE-AIM can be used to evaluate
randomized controlled studies as well as studies with other designs, and it is compatible with
evidence-based medicine.
The framework conceptualizes the public health impact of an intervention as a function
In the past, focus was more on effectiveness, currently it’s more on implementation and reach.
Effectiveness: Would it work in the context, more about external validity.
Efficacy: First thing to study in RTC, is there relation between A and B, related to internal validity.
Reach: Related to target population. Reach is an individual-level measure (e.g., patient or employee)
of participation. Reach refers to the percentage and risk characteristics of persons who receive or are
affected by a policy or program. It is measured by comparing records of program participants and
complete sample or "census" information for a defined population, such as all members in a given
clinic, health maintenance organization, or worksite. Reach (as well as adoption) also concerns the
characteristics of participants. Unfortunately, participants in health promotion activities sometimes
are those who need them least
Efficacy: It is important to assess both positive and negative consequences of programs and
behavioral, quality of life, and participant satisfaction outcomes as well as physiologic endpoints.
Adoption: Professionals. Adoption refers to the proportion and representativeness of settings (such
as worksites, health departments, or communities) that adopt a given policy or program.
There are common temporal patterns in the type and percentage of settings that will adopt an
innovative change. Adoption is usually assessed by direct observation or structured interviews or
surveys. Barriers to adoption should also be examined when nonparticipating settings are assessed.
Implementation: Implementation refers to the extent to which a program is delivered as intended. It
can be thought of as interacting with efficacy to determine effectiveness (Efficacy X Implementation =
Effectiveness). There are both individual-level and program-level measures of implementation.
Maintenance: A major challenge at both individual and organization-community levels is long-term
maintenance of behavior change. At the individual level, relapse following initial behavior change is
ubiquitous. Equally essential is the collection of program-level measures of institutionalization, that
HEP4205
Case 1 10,000 Steps to go
Diffusion: Diffusion is the passive, untargeted, unplanned, and uncontrolled spread of new
interventions. For example: creating a website without spreading.
Dissemination: Dissemination is an active approach of spreading evidence-based interventions to
the target audience via determined channels using planned strategies
Dissemination strategy: Dissemination strategies describe mechanisms and approaches that are
used to communicate and spread information about interventions to targeted users.
Adoption: A decision of an individual or organization to use and implement a new idea (or to study
the consequences of innovation). There are specific active things they need to do.
Implementation: Implementation occurs when an individual (or other decision-making unit) puts an
innovation into use.
Implementation strategy: Systematic processes, activities, and resources that are used to integrate
interventions into usual settings.
The term innovation can refer to “an idea, practice, or object that is perceived as new by an
individual or other unit of adoption.” Some authors use this term interchangeably with the term
evidence-based intervention.
Institutionalization: Eventually a point is reached at which the new idea becomes an institutionalized
and regularized part of the adopter's ongoing operations. The innovation finally loses its distinctive
quality as the separate identity of the new idea disappears. This point is usually considered the end
of the implementation stage and is often referred to as routinization or institutionalization.
It is basically the integration in the culture and into policy, it doesn’t feel like an innovation
anymore.
Similar terms: Maintenance, sustainability
Sustainability: Sustainability describes the extent to which an evidence-based intervention can
deliver its intended benefits over an extended period of time.
Three operational indicators of sustainability are: (1) maintenance of a program’s initial health
benefits, (2) institutionalization of the program in a setting or community, and (3) capacity building in
the recipient setting or community.
Rabin et al. distinguishes 3 stages of institutionalization
1) Passage: A single event such as transition from temporary to permanent funding
2) Cycle of routine: Repetitive reinforcement of the importance of the community procedures
and behaviors, such as the annual budget and evaluation criteria
3) Niche saturation: The extent to which an EBI is integrated into all subsystems of an
organization
,
, The RE-AIM framework (Glagow)
RE-AIM provides a framework for determining what programs are worth sustained investment and
for identifying those that work in real-world environments. RE-AIM can be used to evaluate
randomized controlled studies as well as studies with other designs, and it is compatible with
evidence-based medicine.
The framework conceptualizes the public health impact of an intervention as a function
In the past, focus was more on effectiveness, currently it’s more on implementation and reach.
Effectiveness: Would it work in the context, more about external validity.
Efficacy: First thing to study in RTC, is there relation between A and B, related to internal validity.
Reach: Related to target population. Reach is an individual-level measure (e.g., patient or employee)
of participation. Reach refers to the percentage and risk characteristics of persons who receive or are
affected by a policy or program. It is measured by comparing records of program participants and
complete sample or "census" information for a defined population, such as all members in a given
clinic, health maintenance organization, or worksite. Reach (as well as adoption) also concerns the
characteristics of participants. Unfortunately, participants in health promotion activities sometimes
are those who need them least
Efficacy: It is important to assess both positive and negative consequences of programs and
behavioral, quality of life, and participant satisfaction outcomes as well as physiologic endpoints.
Adoption: Professionals. Adoption refers to the proportion and representativeness of settings (such
as worksites, health departments, or communities) that adopt a given policy or program.
There are common temporal patterns in the type and percentage of settings that will adopt an
innovative change. Adoption is usually assessed by direct observation or structured interviews or
surveys. Barriers to adoption should also be examined when nonparticipating settings are assessed.
Implementation: Implementation refers to the extent to which a program is delivered as intended. It
can be thought of as interacting with efficacy to determine effectiveness (Efficacy X Implementation =
Effectiveness). There are both individual-level and program-level measures of implementation.
Maintenance: A major challenge at both individual and organization-community levels is long-term
maintenance of behavior change. At the individual level, relapse following initial behavior change is
ubiquitous. Equally essential is the collection of program-level measures of institutionalization, that
