Contributions to the literature
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Both dissemination research and policy-focused research are underdeveloped areas of implementation science, especially in the USA.
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Political identity has received little attention as a variable in implementation science.
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The current study illustrates how a cluster randomized design can be used to make causal inferences about the effects of including different types of evidence in dissemination materials for elected policymakers and the moderating effects of political identity.
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Inclusion of economic evidence in dissemination materials increases engagement with dissemination materials among Democrats, but not Republican, elected policymakers.
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Results support the inclusion of economic evidence in dissemination materials for elected policymakers, but also signal the potential value of tailoring dissemination materials for policymakers based on their political party affiliation.
Background
Study context: evidence about adverse childhood experiences, behavioral health, and evidence-supported policy strategies
Prior dissemination research with state legislators and knowledge gap
Study aims and hypotheses
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Inclusion of state-tailored economic evidence about ACEs and state-tailored data about rates of ACEs in dissemination materials (intervention) increases legislator engagement with dissemination materials compared with inclusion of national data about rates of ACEs and no economic evidence (control)
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Inclusion of state-tailored economic evidence about ACEs and state-tailored data about rates of ACEs in dissemination materials (intervention) increases engagement with dissemination materials compared with inclusion of state-tailored data about rates of ACEs and no economic evidence (enhanced control)
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Inclusion of state-tailored data about rates of ACEs and no economic evidence (enhanced control) increases engagement with dissemination materials compared with inclusion of national data about rates of ACEs and no economic evidence (control)
Conceptual framework
Methods
Study design, population, and randomization
Study conditions and dissemination materials
Dissemination procedure
Outcomes and measures
Covariates
Analysis
Results
Intervention | Enhanced control | Control | P | ||||
---|---|---|---|---|---|---|---|
n | % | n | % | n | % | ||
First e-mail (n = 6509) | |||||||
Political party | |||||||
Democrat | 1167 | 48.6 | 1062 | 45.3 | 788 | 44.6 | .02 |
Republican | 1233 | 51.4 | 1281 | 54.7 | 978 | 55.4 | |
Gender | |||||||
Female | 789 | 32.9 | 687 | 29.3 | 517 | 29.3 | .01 |
Male | 1610 | 67.1 | 1656 | 70.7 | 1248 | 70.7 | |
Health background | |||||||
Yes | 93 | 4.2 | 100 | 4.7 | 86 | 5.0 | .50 |
No | 2098 | 95.8 | 2038 | 95.3 | 1622 | 95.0 | |
Race/ethnicity | |||||||
Non-Hispanic White | 1967 | 85.2 | 1788 | 80.9 | 1360 | 77.5 | <.0001 |
Not non-Hispanic White | 341 | 14.8 | 422 | 19.1 | 394 | 22.5 | |
Second e-mail (n = 6153) | |||||||
Party | |||||||
Democrat | 1164 | 48.7 | 954 | 47.6 | 782 | 44.5 | .03 |
Republican | 1227 | 51.3 | 1052 | 52.4 | 974 | 55.5 | |
Gender | |||||||
Female | 785 | 32.9 | 597 | 29.8 | 514 | 29.3 | .03 |
Male | 1605 | 67.2 | 1409 | 70.2 | 1409 | 70.7 | |
Health background | |||||||
Yes | 93 | 4.3 | 87 | 4.8 | 84 | 5.0 | .57 |
No | 2090 | 95.7 | 1744 | 95.2 | 1614 | 95.0 | |
Race/ethnicity | |||||||
Non-Hispanic White | 1962 | 85.3 | 1499 | 79.1 | 1353 | 77.6 | <.0001 |
Not non-Hispanic White | 338 | 14.7 | 397 | 20.9 | 391 | 22.4 |
Effects of dissemination materials on e-mail views
E-mail view | Link click | Request for consultation | ||||
---|---|---|---|---|---|---|
% | p | % | p | % | p | |
First e-mail (n = 6509) | ||||||
All | 18.7 | - | 3.2 | - | 0.3 | - |
Condition | ||||||
Intervention | 22.8 | <.0001 | 3.3 | .77 | 0.3 | .98 |
Enhanced control | 14.9 | 3.2 | 0.3 | |||
Control | 18.5 | 2.9 | 0.2 | |||
Party | ||||||
Democrat | 22.7 | <.0001 | 4.5 | <.0001 | 0.5 | .001 |
Republican | 15.3 | 2.1 | 0.1 | |||
Gender | ||||||
Female | 22.1 | <.0001 | 5.7 | <.0001 | 0.4 | .25 |
Male | 17.3 | 2.1 | 0.2 | |||
Health background | ||||||
Yes | 20.8 | .42 | 4.7 | .12 | 0.4 | .65 |
No | 18.8 | 3.0 | 0.2 | |||
Race/ethnicity | ||||||
Non-Hispanic White | 18.8 | .99 | 3.2 | .75 | 0.2 | 0.41 |
Not non-Hispanic White | 18.8 | 3.0 | 0.4 | |||
Second e-mail (n = 6153) | ||||||
All | 17.7 | - | 2.3 | - | 0.4 | - |
Condition | ||||||
Intervention | 20.9 | <.0001 | 2.1 | .21 | 0.3 | 0.93 |
Enhanced control | 16.1 | 2.8 | 0.4 | |||
Control | 15.2 | 2.1 | 0.3 | |||
Party | ||||||
Democrat | 21.1 | <.0001 | 3.1 | <.0001 | 0.5 | .05 |
Republican | 14.7 | 1.6 | 0.2 | |||
Gender | ||||||
Female | 20.0 | .002 | 3.7 | <.0001 | 0.4 | .57 |
Male | 16.7 | 1.7 | 0.3 | |||
Health background | ||||||
Yes | 17.1 | .69 | 2.3 | .99 | 0.0 | 0.39 |
No | 18.0 | 2.3 | 0.4 | |||
Race/ethnicity | ||||||
Non-Hispanic White | 17.7 | .86 | 2.1 | .37 | 0.3 | 0.09 |
Not non-Hispanic White | 17.9 | 2.6 | 0.6 |
Individual-level model | Multilevel model | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
E-mail view | Link click | Request for consultation | E-mail view | Link click | Request for consultation | |||||||
AOR (95% CI) | p | AOR (95% CI) | p | AOR (95% CI) | p | AOR (95% CI) | p | AOR (95% CI) | p | AOR (95% CI) | p | |
First e-mail (n = 6272) | ||||||||||||
Intervention vs. control (ref) | 1.24 (1.06, 1.45) | .008 | 0.97 (0.67, 1.4) | .87 | 0.84 (0.22, 3.18) | .80 | 1.21 (0.55, 2.66) | .64 | 0.98 (0.51, 1.88) | .95 | 0.87 (0.19, 4.03) | .86 |
Intervention vs. enhanced control (ref) | 1.64 (1.41, 1.91) | <.0001 | 0.92 (0.66, 1.28) | .61 | 0.74 (0.22, 2.43) | .62 | 1.47 (0.70, 3.13) | .31 | 0.94 (0.51, 1.74) | .85 | 0.67 (0.17, 2.68) | .57 |
Enhanced control vs. control | 0.75 (0.64, 0.89) | .001 | 1.06 (0.74, 1.53) | .76 | 1.14 (0.32, 4.07) | .84 | 0.82 (0.37, 1.81) | .62 | 1.04 (0.54, 1.99) | .90 | 1.30 (0.30, 5.65) | .72 |
Democrat vs. Republican (ref) | 1.71 (1.48, 1.98) | <.0001 | 2.09 (1.51, 2.90) | <.0001 | 8.37 (1.77, 39.65) | .007 | 1.49 (1.25, 1.76) | <.0001 | 2.13 (1.50, 3.00) | <.0001 | 8.59 (1.78, 41.48) | .007 |
Non-Hispanic White vs. not Non-Hispanic White (ref) | 1.33 (1.11, 1.59) | .002 | 1.71 (1.16, 2.54) | .007 | 1.37 (0.42, 4.48) | .61 | 1.48 (1.19, 1.83) | .004 | 1.69 (1.12, 2.54) | .01 | 1.43 (0.43, 4.76) | .56 |
Female vs. male (ref) | 1.16 (1.01, 1.34) | .03 | 2.48 (1.84, 3.35) | <.0001 | 0.97 (0.34, 2.77) | .95 | 1.18 (1.01, 1.38) | .04 | 2.50 (1.85, 3.39) | <.0001 | 0.98 (0.34, 2.81) | .96 |
Second e-mail (n = 5940) | ||||||||||||
Intervention vs. control (ref) | 1.43 (1.21, 1.69) | <.0001 | 0.91 (0.58, 1.42) | .67 | 1.02 (0.35, 2.98) | .97 | 1.47 (0.67, 3.2) | .34 | 0.91 (0.47, 1.75) | .77 | 1.02 (0.35, 2.98) | .97 |
Intervention vs. enhanced control (ref) | 1.37 (1.17, 1.61) | <.0001 | 0.75 (0.50, 1.12) | 0.16 | 0.97 (0.40, 2.70) | .95 | 1.18 (0.55, 2.53) | .68 | 0.82 (0.44, 1.55) | .55 | 0.97 (0.35, 2.70) | .95 |
Enhanced control vs. control (ref) | 1.04 (0.87, 1.25) | .65 | 1.22 (0.78, 1.88) | .38 | 1.05 (0.35, 3.14) | .93 | 1.24 (0.56, 2.78) | .59 | 1.10 (0.57, 2.15) | .77 | 1.05 (0.35, 3.14) | .93 |
Democrat vs. Republican (ref) | 1.65 (1.42, 1.92) | <.0001 | 2.07 (1.38, 3.1) | .0005 | 2.55 (0.88, 7.37) | .08 | 1.41 (1.17, 1.69) | .0002 | 1.94 (1.27, 2.95) | .002 | 2.55 (0.88, 7.37) | .08 |
Non-Hispanic White vs. not Non-Hispanic White (ref) | 1.25 (1.04, 1.51) | .02 | 1.29 (0.83, 2.03) | .26 | 0.71 (0.26, 1.95) | .51 | 1.43 (1.14, 1.78) | .002 | 1.33 (0.83, 2.11) | .24 | 0.71 (0.26, 1.95) | .51 |
Female vs. male (ref) | 1.09 (0.94, 1.27) | .24 | 1.88 (1.31, 2.7) | .0006 | 0.85 (0.34, 2.17) | .74 | 1.10 (0.93, 1.30) | .26 | 1.82 (1.26, 2.63) | .001 | 0.85 (0.34, 2.17) | .74 |
Intervention effects on policy brief link clicks
Intervention effects on requests for consultation
Intervention effects on mentions of terms related to ACEs in social media posts and newsletters to constituents
Mention of any terms broadly related to child maltreatment or any explicit mention of ACEs | ||||||
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Unadjusted | Individual-level Model | Multilevel Model | ||||
OR (95% CI) | p | AOR (95% CI) | p | AOR (95% CI) | p | |
Intervention vs. control (ref) | 0.99 (0.72, 1.34) | .93 | 0.98 (0.72, 1.35) | .91 | 0.90 (0.38, 2.12) | .80 |
Intervention vs. enhanced control (ref) | 1.24 (0.90, 1.70) | .19 | 1.22 (0.88, 1.68) | .24 | 1.40 (0.59, 3.34) | .44 |
Enhanced control vs. control (ref) | 0.80 (0.57, 1.12) | .19 | 0.81 (0.57, 1.14) | .23 | 0.64 (0.26, 1.58) | .33 |
Democrat vs. Republican (ref) | 1.76 (1.35, 2.29) | <.0001 | 1.20 (0.88, 1.63) | .25 | 1.15 (0.83, 1.59) | .41 |
Non-Hispanic White vs. not non-Hispanic White (ref) | 0.67 (0.50, 0.91) | .01 | 0.85 (0.60, 1.19) | .34 | 1.04 (0.73, 1.49) | .84 |
Female vs. male (ref) | 2.88 (2.22, 3.74) | <.0001 | 2.62 (1.99, 3.46) | <.0001 | 2.75 (2.08, 3.66) | <.0001 |