Where Have We Been and Where Should We Go?

A major mission of our team is to advance the science of implementation. One of the foremost ways we do this is by providing funding opportunities for researchers to conduct dissemination and implementation studies across health. Now that it’s been over a decade since the Dissemination and Implementation Research in Health (DIRH) Program Announcements have been out on the street, we wanted to take a look and see what we have funded and what gaps remain.

Building off of our previous efforts to analyze the NCI-funded research portfolio, we recently completed an analysis of dissemination and implementation research funded through the DIRH Program Announcements. Since our earlier work from 2012, our portfolio has more than doubled. We wanted to take a deeper dive to understand not only the broad topics and objectives of the funded research, but also to understand specifics about the study populations, types of interventions and how they are delivered, implementation strategies used, study settings, as well as study designs, methods, and measures.

To accomplish this, we collaborated with our colleagues across the NIH and AHRQ to develop a codebook that allows us to capture various details about the study populations, interventions, strategies, designs, methods, measures, and settings for each awarded proposal. After multiple iterations and pilot testing, the final version of the codebook includes 40 questions and takes approximately 30-45 minutes for each proposal. While many of the questions can be answered by reviewing the specific aims alone, raters are required to read the entire research strategy to fully capture all the details. Although relatively time consuming, this allows us to better understand the methods our field has been using and where the gaps exist.

In addition to creating a codebook to analyze our portfolio, we also wanted to develop a platform for our internal use that will allow us to iteratively update our analyses moving forward. The NIH recently released iSearch, which is a convenient and comprehensive platform for coding grants. Not only does it allow you to develop and integrate a codebook into your portfolio, but it also iteratively updates the portfolio as grants are continually being awarded.

Using iSearch, we coded all 68 grants funded by the NCI through the DIRH program announcements. While details are still being written up, we can share with you some general findings. Principally, and perhaps not surprisingly, implementation studies are far more common than dissemination studies. In addition, most studies tested implementation strategies for adoption and implementation while very few examined sustainability, scale up, or de-implementation. We were heartened to see that the clear majority of studies integrated an implementation or dissemination theory, model, or framework into their proposal. However, we were a bit surprised that the array of these theories, models, and frameworks used in grants was fairly limited even though over 60 exist.

As we are approaching the end of the current set of funding opportunities, our portfolio analysis will help us understand the areas in our field that have already been well studied and those to which we need to pay more attention. As we think through changes to the next set of funding announcements, we hope to see more research in the areas of scale-up, sustainability, and de-implementation, as well as measures development. But no need to wait! These opportunities will be open for a whole other year, through June 2019!