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Home > Effective dissemination: A systematic review of implementation strategies for the AOD field.

Bywood, Petra and Lunnay, Belinda and Roche, Ann (2008) Effective dissemination: A systematic review of implementation strategies for the AOD field. Adelaide: National Centre for Education and Training on Addiction.

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Innovations, such as treatment interventions, programs and therapies, may be costly to develop and evaluate and there is increasing political and financial pressure to ensure that effective and cost-effective health care and professional services are available where needed. However, even when practitioners are aware of the evidence for best practice and are willing to change their behaviour, actually making the required changes in the context of long established patterns of behaviour can be difficult, particularly if the organisational environment is not conducive to change. Moreover, innovations are not self-executing. Even simple programs that require only small changes may benefit from an effective implementation strategy.

The National Centre for Education and Training on Addiction (NCETA) undertook a systematic literature review of the most commonly used strategies designed to increase the uptake of innovations into professional practice. Analyses were undertaken to evaluate their effectiveness and to determine their relevance and applicability for use in the alcohol and other drugs (AOD) field. By evaluating and synthesising the evidence from a wide range of sources, NCETA aimed to identify the key factors underlying successful dissemination strategies and develop a framework for dissemination and implementation of innovations in the AOD field.

From the available evidence, strategies found to be effective for changing the behaviour of individual health care professionals (professional interventions) were:
• Educational meetings
• Educational outreach
• Prompts and reminders
• Audit and feedback.

Educational materials alone were not shown to be very effective for improving professional practice. However, their effect was enhanced when delivered in conjunction with other more effective strategies.

Opinion leaders have shown little evidence of effectiveness in changing practitioner behaviour. However, of the few studies undertaken to evaluate the effectiveness of opinion leaders, study quality was generally poor to average.

Compared to the literature evaluating the effectiveness of professional interventions, there were few available studies evaluating organisational strategies. However, results indicated that change at the organisational level is facilitated if implementation strategies consider the following factors:
• Clarity of purpose of a program or innovation
• Limitations of time and resources within an organisation
• Existing workloads and expectations
• Staff cohesion, communication and openness to change
• Workplace culture.

Even if staff are aware of the need to change and accept that an innovation will fulfil their needs, the organisational culture may moderate the effectiveness of strategies used to facilitate uptake. Multi-faceted interventions may also be useful across a broad range of AOD-related areas of practice. However, due to the heterogeneity of studies that comprised different combinations of interventions in diverse settings, it was not possible to identify which particular combination was most effective. Evidence showed that using more strategies was not necessary to improve practice; just a small number of well-chosen strategies targeted to the behaviour and tailored to the setting.

This report is the first part of a 3-part series. (See related link below)
Part Two: Effective Dissemination: An examination of the costs of implementation strategies for the AOD field
Part Three: Effective Dissemination: An examination of the theories and models of change for research dissemination


Item Type
Report
Publication Type
International, Report, Review
Drug Type
All substances
Intervention Type
Education and training
Source
Date
2008
Call No
JG10.4.4.4
Pages
168 p.
Publisher
National Centre for Education and Training on Addiction
Place of Publication
Adelaide
EndNote
Accession Number
HRB 6439 (Available)
Related URLs

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