Frequent Issues in Primary Care Research, with Efficacy and Dissemination and Implementation Science (DIS) Approaches to These Issues
| Content Issue | Efficacy Approach | DIS Approach and Framework Considerations |
|---|---|---|
| Multi-level context of problems and programs | One-level model. Focus is 1:1, patient-provider, or family to health care team only | Multi-level model including individual, organizational and health system levels. Consider CFIR or PRISM and mixed methods context assessments |
| Representativeness (at multiple levels) and Reach | Often not addressed or considered to be not possible to assess or influence | RE-AIM framework focus on adoption, settings, and representativeness |
| Program selection, innovation design, and feasibility | Select maximally effective or most comprehensive program regardless of other factors | Emphasis on feasibility, costs, minimum intervention needed for change (MINC)73 |
| Variability and adaptation—across sites and over time | Considered bad; poor fidelity likely means poor results; hard to standardize | Inevitable, need to study and guide appropriate adaptation to context |
| Sustainability and dissemination of program or innovation | Think about this only at conclusion of evaluation | “Design for Dissemination” from outset of the study |
CFIR, consolidated framework for implementation research; MINC, minimum intervention needed for change; PRISM, practical, robust implementation science model; RE-AIM, reach, effectiveness, adoption, implementation, maintenance.