Organizational Constructs in Dissemination and Implementation Models: A Narrative Review

Background and Purpose. Numerous dissemination and implementation (“D&I”) models have been proposed to close the research-to-practice gap. Tabak et al. (2012) conducted the seminal narrative review of 61 D&I models operating at the individual, community, organizational, and policy/system levels; 58 included organization-level changes. Despite the importance of organization-level understanding in D&I efforts, few studies investigated how D&I models discuss and operationalize organizational constructs (e.g., concepts and variables). This current narrative review updates D&I models operating at the organization-level published up to 2020. We aimed to (1) identify organizational constructs in the 91 existing D&I models and (2) examine the extent to which these constructs operated at the organizational level.

Methods. Guided by Tabak et al.’s (2012) approach, we identified D&I models published up to 2020 operating at the organization-level in three ways: (1) 58 D&I models from Tabak et al.’s study; (2) 25 D&I models from the Health Research and Practice Website (a repository of D&I models); and (3) eight D&I models from a systemic search on the PubMed database using “dissemination,” “implementation,” “evidence-based practices,” and “organization” terms in title or abstract, both separately and in combination. After qualitatively analyzing twenty randomly selected models independently, three coders discussed salient constructs across the models. Over several discussions, we reached an agreement on the six organizational constructs: (1) capacity, (2) policies and procedures, (3) leadership, (4) collaboration, (5) external factors, (6) alignment. After developing a codebook, two coders reviewed all 91 D&I models looking for the constructs.

Results. Out of 91 D&I models, 15 models mainly focused on system-, policy-, or individual-level D&I issues without substantive discussions of the organizational constructs. Of the remaining 76 D&I models, six models (7%) discussed all six constructs, seven models (9%) discussed five constructs, 14 models (18%) discussed four constructs, 20 models (26%) discussed three constructs, 12 models (16%) discussed two constructs, and 18 models (24%) discussed one construct. On average, the models published in the last decade (2011-2020) discussed relatively fewer constructs (2.6 on average) compared to the models published in the earlier decades (3.0 on average). Most D&I models (65 models, 86%) frequently discussed organizational capacity (e.g., D&I effort supporting resources and culture). However, fewer D&I models discussed other organizational constructs important for adopting and sustaining D&I efforts, such as how external and contextual factors’ influence D&I efforts (39 models, 51%), collaboration among stakeholders (e.g., managers, providers, users, and community members) (36 models, 47%), alignment between innovations and organizations (34 models, 45%), leadership commitment and support (25 models, 33%), and policies and procedures incentivizing individual adoption (21 models, 28%).

Conclusions and Implications. This manuscript contributes to D&I literature and practice by identifying salient organizational constructs in the D&I models targeting organization-level changes and examining critical gaps in conceptualizing and practicing organizational changes. Our findings suggest that future D&I practices and studies should consider various organizational constructs that can facilitate and hinder D&I processes and incorporate perspectives of groups who recognize and experience the importance of these constructs (e.g., front-line providers, managers, and organizational scholars).