Background
Building blocks for enhancing D&I research capacity
People: mentoring and interdisciplinary collaboration
Settings: organizational commitment
Activities: trainings, tools, and toolkits
Building D&I capacity in a university setting
Washington University Network for Dissemination and Implementation Research
You’re exposed to the latest and most relevant literature. At every WUNDIR meeting there is an article on methods or a data analysis procedure we’re all learning from.If I were to write a D&I grant I know a lot more about where to find the frameworks, the importance of using a framework, both for the planning of the study and for the measurement.
It’s very inclusive. Everybody gets a change to talk and hear opinions.I think that just being part of this community within our larger Washington University community is a really nice thing. It feels good, it feels like you’re supported, and challenged, and not doing this work in isolation.
It [mock reviews] advances people’s knowledge, it offers opportunity for feedback and review, and it strengthens everyone’s work. I think it gives people a place to start if they are interested in D&I work.It very clearly strengthens capacity in terms of strengthening the quality andalso the volume of D&I grants or D&I related grants that go out. Parallel to that,not only do proposal reviews get supported, but also papers in developmentand other projects.
At the very least [WUNDIR] is one of the first of its kind. I think that has really caught the interest and admiration of others outside of the university and others have started to model similar types of networks within their institutions. I think that providing that model has really been critical to the field of D&I and others taking similar approaches.
Dissemination and Implementation Research Core
Domain | Key questions | Potential challenges |
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1. Main interest/research question(s) | What are you seeking to accomplish? Test a prevention strategy or treatment Implement an evidence-based intervention Disseminate a new intervention/treatment | Too many questions for one study Not a D&I study |
2. Background | Have you conducted a study prior on the program/policy/treatment/intervention? Efficacy Effectiveness Service system Organizational context Treatment/intervention adaptation Early phase D&I study Scale-up potential training | Little efficacy/effectiveness data on intervention |
2. Evidence-based intervention to be implemented | Is the evidence for the program, treatment, or set of services to be implemented demonstrated? | The intervention may not have been proved/tested |
3. Care, burden, or quality gap | What is the quality gap in your program of research/in the study that you are proposing? | The quality gap has not been well documented The prevented fraction has not been estimated |
4. Setting | 1. Who are consumers/patients/clients/stakeholders? 2. Who are the key stakeholders in the implementation and how are they engaged in the proposed study? 3. Who are the providers? What is their level of exposure, training to the intervention of interest? What are the training possibilities? Training challenges? 4. How universal or generalizable is the setting of delivery? (e.g., part of a national system, or network?) | Lack of data on organizational level providers Multilevel interventions many involve many different providers |
5. Study design | 1. How would you describe the study design? Observation of a naturally occurring implementation/dissemination plan to introduce (manipulate) something new (using an implementation or dissemination strategy, comparing the effectiveness of two implementation strategies) 2. What methods will you use? Quantitative only Qualitative only Mixed methods | No local expertise on qualitative methods |
6. Conceptual model and theoretical justification | Do you have a clear conceptual framework/theory/model that informs the design and variables being tested? Does your conceptual model frame your evaluation? | Little to no knowledge about conceptual models |
7. Outcomes | What outcomes are you thinking about evaluating? | Reliable and valid methods for measuring outcomes do not exist |
8. Strategies | What are the strategies you are thinking about using to implement the intervention? | Lack of data on effective strategies |
Topic | Description |
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Introduction to D&I science | Introductory material that includes an overview of the field and terminology |
Aims | Guidance on how to write effective aims |
Barriers and facilitators | Information on how to identify and measure barriers and facilitators |
Research designs | Brief overview of research designs (experimental, quasi-experimental) for D&I studies |
Strategies | Commonly used D&I strategies, including recommendations for reporting in manuscripts |
Organizational measures | Information on organizational constructs and measures to be addressed in a D&I study |
Outcomes | Guidance on which D&I outcomes to include in a study |
Key ingredients in grant proposals | Adapted from Proctor et al. [38], provides 10 ingredients for a successful grant application |
Center for Dissemination and Implementation, Institute for Public Health
I met with [consultant] after sending a draft application for the CTSA Innovation Award. He had reviewed it prior to our meeting and provided very valuable insights and suggestions”… (specifically related to …innovative research methods) “as well as recommending a possible collaborator. The proposal received excellent reviews at study section, in part due to his input.The consultation allowed hospital system partners directly involved with integrating qualitative data with quantitative data the opportunity to learn more about relevant frameworks for implementation and evaluation of different methods for integration.
National/international training programs
The Implementation Research Institute (IRI)
Mentored Training for Dissemination and Implementation Research in Cancer (MT-DIRC)
D&I functions within research centers
Making it happen: the academic trade-offs
Challenge 1: lack of awareness about D&I and how it is defined
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Lay the groundwork for D&I science. We spent considerable time in the early years of this process presenting foundational informational sessions to various audiences across campus. This was a challenge in that this time was often not directly “paid for,” but it was essential in building awareness and education among future partners on the value of D&I science for their work.
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Utilize efficient decision aids. To initially determine whether a proposed project is a D&I study, we have developed a checklist and decision tree. We also provide key implementation articles to individuals seeking advice, including those identifying essential components of implementation research grant proposals [38], conceptual frameworks [44, 45], and articles that help investigators anticipate the potential D&I outcomes for evaluation in the proposal [46].
Challenge 2: the broad scope of D&I science
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Promote active participation across disciplines. Interdisciplinarity is a core element of D&I science [44]. However, at Washington University, taking an interdisciplinary approach to building D&I capacity had more practical effects. By starting out as an interdisciplinary collaborative, WUNDIR was able to be a home for any scientist no matter where they lived in the university. This was communicated in a number of ways—by the variety of meeting topics, by rotating meetings between the various campuses, by explicitly recognizing how other disciplines could enhance research ideas, and by featuring speakers representing various theoretical and methodological traditions. Essentially, the early interdisciplinary focus allowed us to endow WUNDIR with a culture of inclusiveness, which we feel was crucial to its acceptance and eventual success. A cross-disciplinary approach is also effective in reducing the need for every team member to be an expert in D&I science. For example, by involving our DIRC methods core, not every principal investigator needs to become a D&I scholar. Core faculty and staff must listen carefully, learn, identify the core D&I scientific challenge, and draw on a wide range of literature and research methods.
Challenge 3: the need to maintain resources
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Garner institutional commitment and share ownership. At Washington University, we have had strong institutional support for D&I science across many levels including the ICTS, the Institute for Public Health, the Brown School of Social Work, the Siteman Cancer Center, and the Chancellor’s office. University leaders have been enthusiastic and generous, enabling us to support a full-time staff member, a part-time staff member, and numerous part-time research assistants. While the terminology of D&I research can be cumbersome [47], the ultimate goals of D&I (e.g., showing impact in society, connecting research to practice and policy, informing teaching) are fundamental to every academic institution. The support across our institution has also allowed us to share ownership of D&I research across multiple schools and departments.
Challenge 4: the need for academic leadership and networking
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How to foster leadership and broad involvement. Our D&I capacity building efforts have involved a broad range of faculty, staff, and students. For WUNDIR and DIRC, the commitment of senior-level faculty members has been essential for providing technical assistance and mentoring junior scholars. The senior D&I leaders at Washington University provide significant amounts of time to building infrastructure and mentoring junior faculty, often beyond the small amounts of allocated effort. This senior-level leadership has fostered involvement and ownership of many others across all levels (from students to faculty). The close connection with junior faculty members has allowed for their career growth in areas such as methods training and mentorship [49].
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Find ways to learn and network outside of the home institution. Many budding D&I scholars will lack senior mentors and infrastructure in their own institutions. To overcome this challenge, it is helpful to become part of training programs (e.g., the Training Institute for Dissemination and Implementation Research in Health [50]), participate in ongoing webinars (e.g., the Implementation Science Webinar Series [51]), and join peer networks (e.g., the Society for Implementation Research Collaboration [52]).
Challenge 5: the need to balance consultation and time for research
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Build the science. We have sought to focus and maintain attention on building the D&I science in ways that overlap with our service functions, nearly always involving graduate students and junior faculty members (e.g., in grants, scientific articles). These efforts have resulted in advances across numerous areas of D&I science including: models and frameworks [44, 45], D&I strategies [53‐55], D&I outcomes [46], sustainability [56, 57], systems science [23, 58], dissemination planning [59‐61], and the scholarship of training [5, 41, 43].
Challenge 6: how to move beyond the walls of academe
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Extend the reach to stakeholders and low resource settings. Fellowship programs that link academic institutions with practice sites show promise in building D&I research capacity [62]. Building on principles of local ownership and mentoring [63], these efforts often involve training and technical assistance for practice-oriented researchers and community-level partners [64, 65]. The recently launched TRIPLE training is an example of an effort to leverage D&I research-based knowledge for training clinical leaders how to implement evidence-based practices. Washington University seeks to better bridge the clinical and research worlds by linking hospital-based quality improvement with D&I science principles.
Challenge 7: the need to build a greater focus on evaluation
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Develop data systems for evaluation. It is essential to build data bases to help monitor and evaluate D&I capacity building. For efforts such as WUNDIR, this requires data on member characteristics, meeting attendance, grants and publications, and other impacts of participation. These data can be used for process evaluation to improve functioning and to document accomplishments (ongoing quality improvement activities). The data we have collected thus far provide the foundation for a future, more comprehensive impact evaluation.