The concepts of diffusion, dissemination, and implementation are distinguished as progressively more active steps in the process of flowing valid and reliable research information into clinical practice. Using a staged model of behavior change, diffusion is seen as a precursor for dissemination activities, which in turn “predispose” physicians to consider change in their practices. Local implementation activities capitalize on this by “enabling” and subsequently “reinforcing” the desired behavior change. Different skills are needed for each activity. Biomedical journals, with some improvements, are identified as diffusion agents. Collaboration between academics and medical organizations is best suited to the dissemination stage. Local agents, empowered by resources, are best equipped for implementation activities.

Diffusion, dissemination, and implementation are all terms used, sometimes interchangeably, to denote the idea that information must be part of a communication process before it is available as an input to decision-making. Their connotations are, however, quite different.

Diffusion is a passive concept. Light diffuses from a source; it is not targeted; it is haphazard; it is largely unplanned and uncontrolled. Those who receive diffused messages were likely already open to and seeking out the message. They were active seekers in the face of a passive flow of information. This describes the medical journal and the (increasingly rare) medical journal reader seeking the primary source. In a recent survey fewer than 25% of physician leaders regularly did personal on-line searching of the literature and only 5% of community physicians did so. The probability that the contents of a single article in a medical journal will be recalled is obviously very small. Diffusion is a form of communication that works well only when the potential recipients are highly motivated, when the rewards of finding the information are high (such as clear and unambiguous implications for behavior), and when there is a relatively small pool of information, which minimizes the search costs. These conditions do not hold for today’s busy physician faced with conflicting, confusing, and voluminous findings from research.

Dissemination is a more active concept. It not only implies a more aggressive flow of information from the source, almost a launching, but it also implies targeting and tailoring the information for the intended audience. Secondary sources such as meta-analyses, overviews, practice guidelines, consensus statements, and seminal or compelling primary studies are most likely to receive such treatment. Although medical journal publication may be part of a dissemination process, such messages will also be relayed by press coverage, targeted mailings, orchestrated campaigns of oral presentation, and even formal advertising. If the message is relevant for the physician’s practice, there is a good probability that she will be exposed to the message whether she wants such exposure or not. If awareness of a message is the goal, the audience is identifiable and the message tailored to its needs, dissemination is an effective form of communication. For instance, awareness of one consensus statement after a comprehensive dissemination process to all members of that particular specialty was nearly 90%.

Implementation implies that the goal of the communication is, however, to do more than increase awareness. Not only is the message tailored to the needs of a general audience, but also the implications of the message for the specific practices of a specific audience must be highlighted. Implementation involves identifying and assisting in overcoming the barriers to the use of the knowledge obtained from a tailored message. It is a more active process still, which uses not only the message itself, but also organizational and behavioral tools that are sensitive to the constraints and opportunities of identified physicians in identified settings. It is a local process of communication in which appreciation of the research findings is a necessary but not sufficient condition to bring about changes in decision-making that reflect the message from research. It is a persistent process that seeks to communicate the findings from research through numerous routes and in numerous ways that make it difficult for the physician to ignore as she goes about her day-to-day activities.

This article extract was suggested by Antonio Scrocco, Infotech team (Italy) and written and published by Lomas J. Diffusion, dissemination, and implementation: who should do what? Ann N Y Acad Sci. 1993 Dec 31;703:226-35; discussion 235-7. doi: 10.1111/j.1749-6632.1993.tb26351.x. PMID: 8192299.




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