摘要：Objectives. We have described the practice of designing for dissemination among researchers in the United States with the intent of identifying gaps and areas for improvement. Methods. In 2012, we conducted a cross-sectional study of 266 researchers using a search of the top 12 public health journals in PubMed and lists available from government-sponsored research. The sample involved scientists at universities, the National Institutes of Health, and the Centers for Disease Control and Prevention in the United States. Results. In the pooled sample, 73% of respondents estimated they spent less than 10% of their time on dissemination. About half of respondents (53%) had a person or team in their unit dedicated to dissemination. Seventeen percent of all respondents used a framework or theory to plan their dissemination activities. One third of respondents (34%) always or usually involved stakeholders in the research process. Conclusions. The current data and the existing literature suggest considerable room for improvement in designing for dissemination. The effective dissemination of information on priorities, health risks, and evidence-based interventions in public health is a formidable challenge. 1,2 Dissemination is an active approach of spreading evidence-based information to the target audience via determined channels using planned strategies. 3 Studies from both clinical and public health settings suggest that evidence-based practices are not being disseminated effectively. 4–6 For example, in a study of US adults, only 55% of overall care received was based on what is recommended in the scientific literature. 7 In a study of US public health departments, an estimated 58% of programs and policies were reported as “evidence-based.” 8 To illustrate the dissemination challenges and possible solutions, research on evidence-based interventions has now taught us several important lessons: dissemination generally does not occur spontaneously and naturally 4 ; passive approaches to dissemination are largely ineffective 9,10 ; single-source prevention messages are generally less effective than comprehensive, multilevel approaches 11,12 ; stakeholder involvement in the research or evaluation process is likely to enhance dissemination (so-called practice-based research) 13–19 ; theory and frameworks for dissemination are beneficial 20,21 ; and the process of dissemination needs to be tailored to specific audiences. 22 The difficulty in dissemination is the result of differing priorities. 23,24 For researchers, the priority is often on discovery (not application) of new knowledge, whereas for practitioners and policymakers, the priority is often on practical ways for applying these discoveries for their settings. 25 The chasm between researchers and practitioners was illustrated in a “Designing for Dissemination” workshop sponsored by the US National Cancer Institute. 26 In this workshop, all participants acknowledged the importance of dissemination. Researchers reported their role was to identify effective interventions, but that they were not responsible for dissemination of research findings. Similarly, practitioners did not believe they were responsible for dissemination. It has been recommended that researchers should identify dissemination partners before conducting discovery research, so that those who might adopt the discoveries will see the research process and results in a collaborative manner. 24,27 Ultimately, we need to better understand how to design interventions with the elements most critical for external validity in mind, 28–30 addressing these issues during early, developmental phases, and not near the end of a project. 24,31 To date, few studies have evaluated the extent to which researchers are designing their studies for dissemination and how the design process may differ by researcher background and setting of research. In the present study, we described the practice of designing for dissemination (D4D) among researchers in the United States with the intent of identifying gaps and areas for improvement.
