Use of Theory in Design of Dissemination Research : The Partnership for Health Dissemination Experie

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Use of Theory in Design of Dissemination Research
The Partnership for Health Dissemination
Experience

• Karen M. Emmons, Ph.D.
• Janet S. de Moor, MPH, Ph.D.
• Rita Butterfield, Ph.D.
• Elaine Puleo, Ph.D.

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Childhood Cancer Survivors

• 300,000 childhood cancer survivors in US
• 20 smokers

• 60,000 childhood cancer survivors in US smoke
• Long-term follow-up programs provide care to
• large s of survivors

Perfect Opportunity to Disseminate Evidence-Based
Smoking Ixs
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Whats the Evidence-Base?
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Partnership For Health (PFH) Study Design
Baseline Survey
Randomization (n796)

• Intervention Group (n398)
• Physician Message
• Tailored and targeted materials
• Peer delivered phone counseling
• Stage-matched smoking cessation
• NRT

• Self-help Control Group (n398)
• Physician Message
• Self-help materials

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Efficiency
Mass Media
High
Tailored Mats. Telephone Counseling
Pamphlets
Self-help Guides
Reach
Brief Counseling
Group Program
Individual Counseling
Low
High
Intervention Efficacy
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Who are Target Audiences for Dissemination?

• Increase oncologists understanding of the
  importance of providing smoking cessation
  services
• Increase organizational infrastructure for
  smoking cessation within survivorship programs
• Develop mechanisms for offering pharmacotherapy
  to all smokers

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Heuristic Framework Guiding the Dissemination of
PFH
Predisposition/motivation to adopt
PFH
KNOWLEDGE
PERSUASION
DECISION
IMPLEMENTATION

• ORGANIZATIONAL CHARACTERISTICS
• climate
• ? interest
• social influence/norms
• size/structure
• decision-making process

Adoption   Rejection
Level   Quality
Perceived Characteristics of PFH ? relative
advantage ? compatibility ? complexity ?
trialability ? observability

• Capacity
• skills/resources

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Dissemination of PFH
Organization obtains knowledge about PFH
Dissemination through COG
Phase 1
Baseline Survey
DFCI calls and reinforces positive aspects of
program and invites participation
Refuse to participate
Decision Makers decide to adopt program
Randomization
Phase 2
Site-based implementation ? PFH kit sent to
sites ? 2 technical assistance calls
Assisted Implementation ? PFH kit sent to
sites ? 2 technical assistance calls ? DFCI
produces tailored materials
Follow-Up Organizational Survey
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Characteristics of Respondent Organizations
(n132)

• Type of Organization
• - Childrens Hx 58
• - Cancer Center 13
• - General Hx 19
• - Independent practice 2
• NCI Cancer Center 42
• Pedi Onc Pts/year (M) 128
• Survivors in active f-up (M) 272

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Smoking Cessation Services Available to Childhood
Cancer Survivors
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Smoking Cessation Services Available to Childhood
Cancer Survivors
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Prevention Needs of Cancer Survivors
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Attitudes Towards Prevention
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Barriers to Providing Smoking Cessation Services
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Capacity for Smoking Service Delivery

• Offer smoking prevention or cessation?
• Assess smoking status for pts., survivors, and
  parents
• Frequency of assessing survivors smoking status
  
• Have strategy for recording smoking status
• Provide referral mechanisms for smoking services
• Have staff member who oversees smoking services

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Predictors of Offering Smoking Cessation Services

• Organizational Factors Associated with Capacity
  for Smoking Service Delivery
• Type of institution (p.09)
• Barriers (p.0001)
• PIs attitudes towards prevention (p.001)
• Complexity (p.04)

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Predictors of Offering Smoking Cessation Services

• Overall Regression Model (Adjusted R2 .22)
• Barriers (p.0003)
• Attitudes (p.02)
• Type of institution
• Stability
• Complexity
• Interconnectedness

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What Facilitates Dissemination?

• Technology
• Feedback
• Use research as an instrument of intervention, to
  stimulate dissemination process
• Provide effective interventions w/ comprehensive
  protocols
• Provide resources to increase focus on
  implementation
• Link research teams and dissemination settings
  through organization of research
• Infrastructure

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Dissemination of PFH
Organization obtains knowledge about PFH
Dissemination through COG
Phase 1
Baseline Survey
DFCI calls and reinforces positive aspects of
program and invites participation
Refuse to participate
Decision Makers decide to adopt program
Randomization
Phase 2
Site-based implementation ? PFH kit sent to
sites ? 2 technical assistance calls
Assisted Implementation ? PFH kit sent to
sites ? 2 technical assistance calls ? DFCI
produces tailored materials
Follow-Up Organizational Survey
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Dissemination of PFH Phase 2
Randomization (n35)
Site-based implementation (n17) ? PFH kit sent
to sites ? 2 technical assistance calls
Assisted Implementation (n18) ? PFH kit sent to
sites ? 2 technical assistance calls ? DFCI
produces tailored materials
Smokers Enrolled (n0)
Follow-Up Organizational Survey
Follow-up Patient Survey
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What do these results mean?

• We failed?

• We learned!

• There is tremendous room for growth within
  pediatric survivorship care to address smoking
• Infrastructure support is critical
• Dedicated staff
• Technology-based efforts
• More integrated, personal efforts are needed
• Technology may be key

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