Behavioral and Social Sciences Research Branch, DER, NIDCR
Objective
The goal of this initiative is to encourage studies aimed at reducing the time between establishment of the evidence base of interventions and widespread uptake and adoption. This initiative will develop implementation strategies tailored for use in dental care and oral health settings. This initiative also provides an opportunity to build the dental/oral/craniofacial implementation science workforce. Some examples of evidence-based interventions in dental practice include:
- Placement of sealants
- Screening, Brief Intervention, and Referral to Treatment (SBIRT) for tobacco and alcohol use
- Rubber dam usage
Additionally, there is benefit in understanding the need to “de-implement” or reduce the use of strategies and procedures that are no longer supported by the evidence, but have been prematurely widely adopted, or are potentially harmful.
Background
It is known there is significant delay between the publication of findings from clinical studies on medical treatments and uptake of these evidence-based interventions in patient care. Dentistry is not immune to this. Historically, the conclusion of a successful intervention study would be to present findings at scientific meetings and publish results in refereed journals to disseminate these findings with the assumption that implementation would naturally follow. For some evidence-based interventions, focused trainings have been used in an attempt to increase adoption. Despite these efforts, the gap remains between the establishment of the evidence and wide spread adoption.
Implementation science is focused on identifying, understanding, and overcoming barriers to the adoption, adaptation, integration, scale-up and sustainability of evidence-based interventions, tools, policies, and guidelines. Understanding the pipeline from development of the evidence base to implementation will improve the quality of dental care provided.
Gaps and Opportunities
The time lag between evidence and uptake is related to many factors, such as low demand or low of interest for the new intervention, push from patients to continue the old intervention, and lack of infrastructure to adopt the new intervention. Successful implementation strategies attack the problems from multiple levels. It is also important to note that developing and testing an intervention is fundamentally different from implementation of that intervention. For some researchers, publication of findings is the end goal. Those who wish to move their research from efficacy testing to implementation may not have the training or experience to conduct implementation.
Despite numerous advances in implementation science made in other fields such as treatments for cancer and substance abuse, there is an opportunity to address the unique aspects of dentistry. Within dentistry, the ADA, AAPHD, AAP and other professional organizations provide evidence-based guidelines. These guidelines serve as a foundation for identifying those interventions ready for implementation.
Current Portfolio Overview
The NIDCR participates in the NIH-wide Dissemination and Implementation Funding Opportunity Announcements (PAR-13-054, PAR-13-055, PAR-13-056) but the response has been modest. Since 2010 the NIDCR received 17 applications through these FOA’s with four being funded. Three of these are on implementation strategies and the other is focused solely on dissemination.
Individuals and Groups Whose Input was Solicited for This Initiative
The NIDCR held an expert panel meeting in April 2015. Participants included established dental/oral/craniofacial researchers and experts in implementation science from other disciplines. Key recommendations from this meeting include:
- Make Implementation Science resources more accessible to the existing oral health research community
- Build interest in Implementation Science research among key stakeholders
- Encourage "Pre-implementation" efforts, such as measuring the baseline and identifying changes in the evidence base
A summary of the meeting (PDF - 222 KB) is available on the NIDCR website.
Implementation science was also identified as an area needing attention among public comments in response to NIDCR’s Request For Information on FY2017 NIDCR Initiatives.
The NIH Office of Behavior and Social Science Research (OBSSR) has expressed interest in partnering with NIDCR in support of this initiative.
Alignment with Institute Goals and Strategic Plan
This initiative is aligned with the NIDCR Strategic Plan 2014–2019, Goal 1, Objective 1-4: Maintain the role of NIDCR as a trusted source of information and evidence related to dental, oral, and craniofacial health; and Goal 3, Objective 3-2: Foster research to promote the translation of scientific knowledge into community-based action.
References
Curran GM, Bauer M, Mittman B, Pyne JM, and Stetler C (2012). Effectiveness-implementation Hybrid Designs: Combining Elements of Clinical Effectiveness and Implementation Research to Enhance Public Health Impact, Medical Care. 50(3):217-226
Damschroder LJ, Aron DC, Keith RE, Kirsch SR, Alexander JA, and Lowrey JC (2009). Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science, Implementation Science. 4(1):50
Davis D, Evans M, Jadad A, Perrier L, Rath D, Ryan D, et al (2003). The case for knowledge translation: shortening the journey from evidence to effect, BMJ. 327(7405):33-5.
Green LW, Ottoson JM, García C, Hiatt RA, and Roditis ML (2014). Diffusion theory and knowledge dissemination, utilization and integration, Frontiers in Public Health Service Systems Research. 3(1):3.
Proctor EK, Landsverk J, Aarons G, Chambers D, Glisson C, and Mittman B (2009). Implementation research in mental health services: An emerging science with conceptual, methodological and training challenges. Administration and Policy in Mental Health, 36(1): 24-34.
Proctor EK, Silmere H, Raghavan R, Hovmand P, Aarons G, Bunger A, et al (2011). Outcomes for implementation research: Conceptual distinctions, measurement challenges, and research agenda. Administration and Policy in Mental Health. 38(2):65-76.
Tabak RG, Khoong EC, Chambers DA, and Brownson RC (2012). Bridging research and practice: Models for dissemination and implementation research. American Journal of Preventive Medicine, 43(3):337-350.