EFN Secretary General Paul De Raeve and Patricia Davidson, Dean of the School of Nursing at Johns Hopkins University, review the social impact of current science dissemination strategies.
Improving health outcomes is dependent on a range of factors. The efficacy of dissemination and implementation science relies on sowing the seeds of change in policies, service delivery, and societal behaviour in order to raise awareness and provoke audience engagement.
Dissemination science – setting the scene
The US National Institutes of Health (NIH) describes dissemination as the targeted distribution of information and intervention materials to a specific public health or clinical practice audience. Dissemination is seen as playing a key role in building sustainable health and social ecosystems while supporting society. Securing a long term societal, political, economic, environmental and scientific impact through dissemination efforts can lead to broader societal changes.
Schipper et al. (2016) suggest that innovation in healthcare often does not include end users and that as a result, it is only understandable for those who have developed it. A way to tackle this challenge would be to start defining the dissemination at the very beginning and to run parallel throughout the project life cycle: if the end users are involved in all the stages of development, the outcome will adapt to their needs and capabilities.
Visser et al. (2005) argue that in co-design, different experts come together. These are researchers, designers/developers, and end users – the latter are ‘experts in their experiences’. The designers benefit from co-design because it facilitates the creative process and organises the project more efficiently and effectively; end users create a better fit between the project’s offer and their needs; and the organisations involved improve their creativity, put their focus on the end users, and enhance their capabilities for innovation.
Lafrenière et al. (2013) examined knowledge dissemination interventions, determining their effectiveness on knowledge acquisition, modifications in attitudes, and changes in practice; and concluding that interventions have a stronger impact on the acquisition of knowledge and changes in attitudes than on changes in practice. Dissemination resources, compared to the overall management of the project resources, are often not taken seriously by consortium stakeholders. Increasing the emphasis on implementation science has the potential to address this.
Neta et al. (2015) claim that a major challenge for practitioners and policymakers is that most evidence-based interventions are not ready for dissemination, and when they are, they take a long time to gain traction. Including stakeholders, practitioners, and other end users from the early stages of research, development and planning would address this issue. It is important for end users to understand how project developers think that their work has an added value for end user’s daily life and wellbeing.
Stakeholder and end user engagement on co-design
Positive dissemination engages with the end user and understands the needs of the audience. The end user should be engaged from in the early definition of the conceptual model of the project, throughout its entire lifecycle, and after the project’s output is released. Regardless of the framework, model or strategy developed, it is key to measure the impact of dissemination on deployment (exploitation) and societal change achieved. The EU Commission defines dissemination as the sharing of results with potential users; however, the authors believe that the framework should take citizen empowerment as its point of departure. The steps to follow to achieve excellence should be laid out in the project’s proposal with key performance indicators (KPIs) linked to dissemination.
In the current health and social care ecosystems, three key stakeholder groups should be considered in dissemination frameworks:
· Policymakers and politicians: engagement is needed to consider the extent to which what has been planned is achievable, cost effective and sustainable;
· Service providers (public or private): assess what is planned and decide whether it can be delivered as part of their current activity within allocated resources and considering feasibility and affordability; and
· Citizens/end users: engage them in developing research questions and engage in study design. Importantly, they need to actively participate in the implementation of research.
Costa and Pesci (2016) conclude that social impact measurement depends upon the perceptions and judgements of different stakeholders with various needs, depending on their relationships with the organisation. Consequently, to measure impact, it is important to explore the coalition network properties and activities and evaluate how these properties in relation to measuring the dissemination impact. It is key to use reliable and valid measures of assessment. There is a clear need to move beyond traditional approaches to innovative methods of engagement.
Determining impact
As part of Horizon 2020, measuring impact is crucial to advance research and innovation. The ‘Implementation research call for scaling up digital solutions’, as an example, refers to impact when the proposal:
· Has the availability of methods and strategies for the implementation of innovative, ethically and legally sustainable solutions aiming at improving people-centred care;
· Gives a better understanding of organisational and system changes, as well as social and behavioural changes required to successfully embed evidence-based innovative solutions involving digital tools into daily practice and ensure their sustainability;
· Increases scaling up and transfer of innovative solutions improving people-centred care in Europe; and
· In the medium and long term, health services get more responsive to the needs of people and their carers (formal and informal), more effective, efficient and equitable health systems.
Nursing researchers, often in contrast to policymakers, see impact as what makes the difference between rhetoric and frontline change. It is therefore key that the conceptual model used to measure impact in general terms relates to the change in attitude/practice and knowledge through citizens empowerment. Effective metrics about the scale, scope and impact at the micro, meso, and macro levels are critical to guiding excellence in research.
The authors agree with Costa and Pesci’s (2016) argument that it is useless to establish metrics of social impact without having a theoretical framework. The multiple-constituencies-based approach (De Raeve, 2014), an organisational theory that argues that the effectiveness of an organisation cannot be considered as an objective reality; rather, as a social construction that depends on the viewpoints of the different stakeholders, is a useful framework for better measuring impact.
Achieving societal impact
The primary long term goal of dissemination is to have an impact in the form of behaviour change and/or knowledge transfer. However, the concept of social impact has been defined as the long term results of an organisation’s activity in terms of economic, environmental and societal change (Ebrahim & Rangan, 2010); and as such the concept of impact becomes anchored in the theory of change: in a focused theory of change, the relationship between cause and effect is linear and clearly understandable; while in a complex theory of change, the relationship between cause and effect is explained by multiple causal factors and is more challenging to understand.
We agree with Costa and Pesci (2016) that this approach to social impact measurement primarily affects the viewpoint of investors. Other scholars have suggested that stakeholder engagement should be about detecting real stakeholders’ needs (Arena et al., 2015). McLoughlin et al. (2009) present a holistic impact measurement model: social impact for local economies. In defining the scope of an organisation, this model considers an understanding of what is most important for key stakeholders.
Conclusion
Within the health and social care ecosystem, dissemination relates to the successful engagement of all healthcare professionals, and patients/citizens with the latest advances brought by healthcare innovation. To achieve societal impact for different stakeholders, dissemination strategies need to focus on co-designing a common consortium strategy, prior to submitting any proposal, for dissemination with measurable targets. Therefore, an understandable and clear proposal, including a dissemination plan, in a suitable format for citizens and stakeholders to engage, facilitates better outcomes and deployment. As we strive for greater accountability and value-based health systems, strengthening methods of dissemination and engagement are critically important. Further research on the effectiveness of these strategies as well as the barriers and facilitators of implementing these methods is required.
References
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Prof Dr Paul De Raeve, RN, MSc, MStat, PhD
Secretary General
European Federation of Nurses Associations
Professor Dr Patricia Davidson, RN, PhD, MEd, FAAN
Dean
Johns Hopkins University School of Nursing
http://www.efnweb.eu
https://nursing.jhu.edu/
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