Where is policy in dissemination and implementation science? Recommendations to advance theories, models, and frameworks: EPIS as a case example
Crable, EL (通讯作者),Univ Calif La Jolla, Dept Psychiat, San Diego, CA 92093 USA.;Crable, EL (通讯作者),Child & Adolescent Serv Res Ctr, San Diego, CA 92123 USA.;Crable, EL (通讯作者),Univ Calif San Diego, Disseminat & Implementat Sci Ctr, Altman Clin & Translat Res Inst, San Diego, CA 92093 USA.
BackgroundImplementation science aims to accelerate the public health impact of evidence-based interventions. However, implementation science has had too little focus on the role of health policy - and its inseparable politics, polity structures, and policymakers - in the implementation and sustainment of evidence-based healthcare. Policies can serve as determinants, implementation strategies, the evidence-based thing to be implemented, or another variable in the causal pathway to healthcare access, quality, and patient outcomes. Research describing the roles of policy in dissemination and implementation (D & I) efforts is needed to resolve persistent knowledge gaps about policymakers' evidence use, how evidence-based policies are implemented and sustained, and methods to de-implement policies that are ineffective or cause harm. Few D & I theories, models, or frameworks (TMF) explicitly guide researchers in conceptualizing where, how, and when policy should be empirically investigated. We conducted and reflected on the results of a scoping review to identify gaps of existing Exploration, Preparation, Implementation, and Sustainment (EPIS) framework-guided policy D & I studies. We argue that rather than creating new TMF, researchers should optimize existing TMF to examine policy's role in D & I. We describe six recommendations to help researchers optimize existing D & I TMF. Recommendations are applied to EPIS, as one example for advancing TMF for policy D & I. Recommendations(1) Specify dimensions of a policy's function (policy goals, type, contexts, capital exchanged). (2) Specify dimensions of a policy's form (origin, structure, dynamism, outcomes). (3) Identify and define the nonlinear phases of policy D & I across outer and inner contexts. (4) Describe the temporal roles that stakeholders play in policy D & I over time. (5) Consider policy-relevant outer and inner context adaptations. (6) Identify and describe bridging factors necessary for policy D & I success. ConclusionResearchers should use TMF to meaningfully conceptualize policy's role in D & I efforts to accelerate the public health impact of evidence-based policies or practices and de-implement ineffective and harmful policies. Applying these six recommendations to existing D & I TMF advances existing theoretical knowledge, especially EPIS application, rather than introducing new models. Using these recommendations will sensitize researchers to help them investigate the multifaceted roles policy can play within a causal pathway leading to D & I success.