Key dissemination factors for a school-based asthma therapy program: a narrative inquiry
Samantha M Harden, Jill S Halterman, Elizabeth D Allen, Mary Kay Irwin, Phoebe Marx, Kimberly ArcoleoAbstract
Background
Evidence-based interventions (EBIs) exist across settings to promote health and prevent disease, yet dissemination—the strategic packaging and sharing of information—often receives less attention, funding, and methodological rigor than implementation science. There is a need to understand the dissemination pathway of an EBI over time to improve dissemination outcomes (e.g. comprehension, exposure, perceived fit).
Methods
Using a school-based asthma therapy (SBAT) program as an example, we applied a narrative inquiry approach to (i) adapt the model for dissemination of research based on program-specific sources, channels, messages, and audiences; (ii) use team members’ lived experiences to understand the evolution of the EBI; and (iii) illustrate core functions of SBAT and provide example implementation approaches and adaptations. Five of six interdisciplinary research and delivery team members were interviewed. Sessions were audio-recorded, transcribed verbatim, and analyzed using three analytic lenses: (i) participant voice from research and delivery team members; (ii) EBI implementation domains (context, content, training, evaluation); and (iii) reflexive monitoring by the inquirer.
Results
Four major themes were derived from the contextual and content analyses: (i) How it started: the value of interpersonal connection (I kind of chuckled, and the group looked at me, ‘Why are you laughing?’ I said, ‘Well, because [we] have been colleagues and friends since the 90s’); (ii) Why it worked: advocating for service- and solution-driven team science (We knew medications were making a difference, but kids weren’t getting them… how do we make sure the whole system can work?); (iii) How it worked: realistic resource needs and strong stories (We had the pharmacy itself has a whole infrastructure that it had to build to be able to get all the prescriptions up and running); and (iv) Keep it going: addressing the invisible work. “There was actually talk of… trying to get it out into… a pretty rural area…but the challenge there was going to be kind of some local boots on the ground invisible support.”
Conclusions
A team science approach is needed for effective dissemination and implementation of EBIs. All interviewees recalled similar threads of channels, sources, messages, and audiences to ensure successful dissemination of this specific SBAT program. Implementation success attributed to infrastructure and “moving cogs” the “invisible work” needed for a “complex system” to work. A limitation is that narrative inquiry relies on the researcher’s “personal wisdom, skills, integrity” and context for interpretation and thus, is subjective.