Table 1.

Frequent Issues in Primary Care Research, with Efficacy and Dissemination and Implementation Science (DIS) Approaches to These Issues

Content IssueEfficacy ApproachDIS Approach and Framework Considerations
Multi-level context of problems and programsOne-level model. Focus is 1:1, patient-provider, or family to health care team onlyMulti-level model including individual, organizational and health system levels. Consider CFIR or PRISM and mixed methods context assessments
Representativeness (at multiple levels) and ReachOften not addressed or considered to be not possible to assess or influenceRE-AIM framework focus on adoption, settings, and representativeness
Program selection, innovation design, and feasibilitySelect maximally effective or most comprehensive program regardless of other factorsEmphasis on feasibility, costs, minimum intervention needed for change (MINC)73
Variability and adaptation—across sites and over timeConsidered bad; poor fidelity likely means poor results; hard to standardizeInevitable, need to study and guide appropriate adaptation to context
Sustainability and dissemination of program or innovationThink 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.